心律失常鉴别.pptVIP

* QRS Duration Normal: 0.06 - 0.10s * Q波正常应不超过R波的1/4 * QT间期：0.27-0.43（延长见于药物中毒/或电解质紊乱） R-R：0.6-1 Q-T延长常见原因 Drugs (many antiarrhythmics, tricyclics, phenothiazines, and others)  Electrolyte abnormalities ( K+, Ca++, Mg++)  CNS disease (especially subarrachnoid hemorrhage, stroke, trauma)  Hereditary LQTS (e.g., Romano-Ward Syndrome)  Coronary Heart Disease (some post-MI patients)  * Ventricular rate Select an R wave that falls on a dark vertical line. Number the next 6 consecutive dark vertical lines as follows: 300, 150, 100, 75, 60, and 50 Note where the next R wave falls in relation to the 6 dark vertical lines already marked. This is the heart rate. * * *Researchers working on the “epidemiology” of out-of-hospital cardiac arrest rhythms have arbitrarily(武断地, 任意地)drawn the line between PEA and “asystole with a few complexes” at 6 “complexes” per minute: more than 6 per minute is PEA, and fewer than that is asystole. * 房室结水平的IIIO AVB，Third-degree AV block at level of AV node, Atrial rhythm is slightly irregular due to presence of sinus arrhythmia, ventricular rhythm is regular at slower rate(44 beats/min). There is no constant PR interval. The QRS complexes are narrow. Indicating supraventricular origin below level of block. * 年轻人多见，因迷走张力改变（胸内压改变）而致 吸气时快，呼气时慢 吸气末时，肺牵张反射↑↑胸腔内压↑↑ →迷走张力↑ →呼气时慢；呼气末，肺牵张反射↓ ↓ →迷走张力↓ →吸气时快 * * * Junctional Escape 交界性逸搏 Ventricular Escape 室性逸搏 * Junctional Escape Complexes 房室交界性逸搏(Lead 2) * * * WPW * * * * 致命性心律失常 室颤/无脉搏性室速：除颤、CPR、药物（肾上腺素/加压素、胺碘酮） 停搏/PEA：CPR、肾上腺素、阿托品、寻找可逆原因 潜在致命性心律失常 症状性心动过缓/房室传导阻滞：阿托品、起搏 房颤/房扑：控制心室率、抗凝剂、药物或电转复 PSVT：迷走神经手法、药物、电复律 室性心动过速：胺碘酮、利多卡因、电复律；尖端扭转性室速：硫酸镁 早搏：戒烟、去除诱因（刺激物或咖啡因） * * 应快速根据以下情况进行心律失常的分类： 心率监测情况 对灌注的影响 除颤或非除颤节律 Heart Rate 心率 Classification 分类 Description 种类 General Treatments 常规治疗 Slow 慢 Brady-arrhythmia’s 心动过缓 SB, 1st Degree, 2nd Degree I II, 3rd Degree 窦缓、一二三度传导阻滞 ABC’s- Atropine- Pacing-Infusions ABC支持-阿托品-起搏-输液 Fast 快 Tachy-arrhythmia’s 心动过速 Wide- Ventricular 宽波-心室 ABC’s