起搏器更多感应装置的植入为我们带来了什么史浩颖幻灯片.pptVIP

临床充血仅仅是冰山的一角，在慢性心衰患者中，即使是严重的血流动力学充血也很少引起肺部罗音和胸片的改变。这是由于代偿机制，比如肺泡毛细血管膜的增厚，淋巴回流的增加，和肺高压。血流动力学充血也有很多的危害，进一步激活神经激素，引起内皮下缺血，导致心肌坏死，左室重构，继发性二尖瓣反流，右房压力增高也引起心肾综合征 临床充血仅仅是冰山的一角，在慢性心衰患者中，即使是严重的血流动力学充血也很少引起肺部罗音和胸片的改变。这是由于代偿机制，比如肺泡毛细血管膜的增厚，淋巴回流的增加，和肺高压。血流动力学充血也有很多的危害，进一步激活神经激素，引起内皮下缺血，导致心肌坏死，左室重构，继发性二尖瓣反流，右房压力增高也引起心肾综合征 The use of intrathoracic impedance to monitor pulmonary congestion/edema. The OptiVol fluid status monitoring (Medtronic, Inc., Minneapolis, MN) measures intrathoracic impedance many times a day using the vector between the device case and the right ventricular lead. As fluid is retained in the lungs because of worsening heart failure (HF), the impedance decreases. OptiVol fluid status monitoring is not initiated until 34 days after implant because the earlier data may be affected by postsurgical edema and inflammation in the pocket area and may not reliably indicate worsening pulmonary congestion. Algorithm to track fluid accumulation. The OptiVol (Medtronic, Inc., Minneapolis, MN) algorithm calculates a number of values to aid in tracking intrathoracic fluid accumulation. (A) The average daily impedance is an average of 64 impedance measurements made between noon and 5 PM. The reference impedance is initialized 34 days after implant by averaging the last 4 average daily impedance values. The trend then adapts slowly to fluid changes and is a reflection of each patient’s fluid status. (B) Cumulative consecutive negative deviations between the average daily impedance and the reference impedance are plotted to create the OptiVol fluid index, which is a measure of the magnitude and duration of an impedance reduction. Margaret Everhart病人初始发生了气急恶化的症状由支气管炎引起，起搏器容量指数阴性确认了症状与心衰的恶化无关。 随后的随访中，病人有充血的症状，容量诊断参数与症状相符（在症状出现前已发生容量指数的增高） 最后病人发生了体重增加25bl，容量监测的结果阴性与体格检查相符。 4.14.05 BNP 185 4.18.05 BNP 221 5.23.05 BNP 153 5.26.05 BNP 107 The Venn diagram shows that 72% of evaluations had 2 HF device diagnostics triggered with the remaining 28% triggered by OptiVol Fluid Index