临时心脏起搏术.pptVIP

不同部位起搏心电图特点 右心房下部起搏?  不同部位起搏心电图特点 右心房下部起搏 起搏心电图 Paced Interval 起搏间期 Paced Interval PACE INDICATOR：起搏指示器 RATE DIAL：频率刻度盘LOW BATTERY INDICATOR：低电池电压指示器OUTPUT DIAL：输出刻度盘SENSITIVITY DIAL：灵敏度刻度盘BATTERY DRAWER RELEASE BUTTONS 电池盒打开钮FLIP-UP COVER (CONCEALS RAP CONTROLS)：翻盖（隐蔽着RAP的控制器）RAPID ATRIAL PACING (RAP) CONTROLS：快速心房起搏器（RAP）控制器SENSE INDICATOR：感应指示器CONTROL COVER：控制盖ON/OFF CONTROLS：开/关控制键BATTERY DRAWER：电池盒 起搏电参数调节 起搏频率 起搏器连续发放脉冲的频率。一般为40-120次/分，通常取60次/分为基本频率。 起搏阈值 引起心脏有效收缩的最低电脉冲强度。心室起搏要求电流3-5mA，电压3-6V。 感知灵敏度 起搏器感知R波的能力。心室感知灵敏度值一般为1-3mV。 并发症 穿刺并发症 常见于：动脉撕裂、皮下血肿、气胸、血胸、气栓等。 锁骨下静脉穿刺的气胸、血气胸发生率较高（1%～5%）。股静脉穿刺则多伴发静脉血栓（25%～35%）及感染（5%～10%）。 电极移位 为临时起搏最常见并发症，一般发生率2%-8%。心电图表现为不起搏或间歇性起搏。需要重新调整电极。 心肌穿孔 该并发症的发生率相对较低，大约为0.1%。与导线插入技术相关的并发症。 电极断裂 因导管质地硬，柔韧性差，反复使用，如放置时间长和体位活动，可能发生导管不完全性断裂。 并发症 膈肌刺激 电极插入位置过深，电极靠近膈神经所致。可将导管退出少许。 心律失常 最常见的是室性异位心律，多不需特殊处理。 感染 可引起局部或全身感染。一般程度轻，应用抗生素或拔除导管后感染即可控制。临时起搏导管一般留置时间最好不超过一周。 并发症 谢谢！ * * Source Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316:1371-1375. [ALL] Coronary remodeling is an adaptive process by which the arterial wall changes in shape to maintain flow, despite the encroachment of plaque. This process may explain why less severe luminal narrowing may still be associated with progressive atherosclerosis and CAD. As plaque accumulates, the arterial wall reacts by remodeling. As atherosclerosis progresses toward the more severe stages pictured on the right, the lumen remains relatively constant because of compensatory expansion of the arterial wall. Eventually, in more severe stages of the disease, the artery is unable to expand further and the lumen begins to narrow. The same process may work in reverse with disease regression. That is, plaque can be removed from the arterial wall with little change in lumen size. Therefore, luminal measurement by quantitative coronary angiography (QCA) may be a less sensitive marker for the progr