培训课件-危重心律失常.ppt

1、一个或多个PP间距显著延长2、长PP间距与窦性心律的基本PP间距之间无整倍数关系。 2.8 秒停搏 窦性停搏心电图 PR间期进行性延长，直至一个P波受阻不能下传心室，RR间距逐渐缩短，直至QRS脱落。 200 360 400 毫秒 毫秒 毫秒 无QRS IIo I 型房室传导阻滞 心电图  1、PR间期固定，正常或延长2、心室脱漏搏动前后的PR间期不改变 P P QRS IIo II 型房室传导阻滞心电图 全部P波不能下传，P波与QRS波群无固定关系。 IIIo 房室传导阻滞心电图 严重缓慢性心律失常的急诊处理 1、积极寻找并治疗可逆性诱因，包括肺栓塞、急性下壁心肌梗死、心肌炎、低血容量、低氧、心包填塞、张力性气胸、酸中毒、药物过量、体温过低、高钾血症等 2、轻微的心动过缓50-60bpm如无症状，无需处理 3、症状性心动过缓 阿托品（窦性心动过缓，窦性停搏，二度1型房室传导阻滞）1-2毫克皮下或者静脉注射。 异丙肾上腺素（阿托品无效）静滴或者泵入，2-10微克/分。易诱发心律失常，恶心呕吐。心肌缺血、高血压慎用。避免高剂量、快速静脉应用。 4、使用临时起搏器 Sinus bradycardia occurs when the SA node fires at a slow 60 bpm rate. Sinus arrest occurs when there is a pause in the rate at which the SA node fires. With sinus arrest there is no relationship between the pause and the basic cycle length. Second-degree AV block is characterized by intermittent failure of atrial depolarizations to reach the ventricle. There are two patterns of second-degree AV block. The first, Type I, is marked by progressive prolongation of the PR interval in cycles preceding a dropped beat. This is also referred to as Wenckebach or Mobitz Type I block. The AV node is most commonly the site of Mobitz I block. The QRS duration is usually normal. Mobitz Type II second-degree AV block refers to intermittent dropped beats preceded by constant PR intervals. To differentiate Mobitz I from Mobitz II, note the PR interval in the beats preceding and following the dropped beat. If a difference between these two PR intervals is more than 0.02 seconds 20 msec , then it is Mobitz I. If the difference is less than 0.02 seconds, then it is Mobitz II. The infranodal His bundle tissue is most commonly the site of Mobitz II block. Note: Advanced second-degree block refers to the block of two or more consecutive P waves i.e., 3:1 block . Third-degree AV block is also referred to as complete heart block. It is characterized by a complete dissociation between P waves and QRS complexes. The QRS complexes are not caused by conduction of the P waves through the