人工心脏起搏器课件篇.pptVIP

起搏故障的原因 起搏脉冲发生器故障 起搏电极导线故障 心肌组织病变 其他（技术或医源性原因） 起搏器故障心电图 间歇起搏 起搏停止 感知功能障碍 起搏频率改变 特殊功能丧失 起搏器故障一般概述 * 起搏器故障检查程序 病史：症状、心梗史、服药史、外力外伤、声、强磁场、电击 体检：特殊心音、心杂音、摩擦音、腹肌或隔肌抽动、埋植部位跳动 辅助检查：心电图、Holter、胸片、超声、磁铁试验、程控试验 起搏系统： 起搏器型号、类型、植入日期、是否顺利、年限和指标 导线型号、植入日期、类型（单双极、心房心室、主动、被动、部位） 起搏参数：植入时测试参数、近期程控参数（时间、原因、变化） * 谢 谢 * * 心率的改变对老年人尤为重要，因为他们甚至在日常活动中都需要动用心率储备。 Heart rate variability is especially important for nearly all elderly patients since they rely on heart rate reserves even during normal daily activities. * * 临时起搏器的图片 * * * 说明左心室电极的放置方法 心房 右心耳 (右房) 双心室 右室心尖部 (右室) 冠状静脉 (左室) * * INSYNC的适应症 * * * * VVI/R起搏模式主要用于症状性心动过缓伴慢性房颤的病人。慢性房颤或心房组织无兴奋性的状况下，心房不能发出有用的节律，因此无法达到房室同步的目的，只有VVI/R两种模式可选。VVIR比VVI更好一些，因为患者在适度活动时可以得到频率适应性起搏，特别是对于已经丧失了房室传导功能的患者。 心室起搏可能导致一些不良反应，如房颤、中风、充血性心力衰竭和起搏综合征(主要是由于丧失房室同步而致血液动力学不良的症状和体征)。这些不良反应既可见于VVI也见于VVIR模式，休息和活动状态都可发生。 所以，尽管心室起搏改善了心房状况不稳定患者的生活质量，但还不是理想的起搏治疗方式。 VVI/R pacing is clearly indicated only for patients with chronic atrial fibrillation associated with symptomatic bradycardia. In the presence of chronic atrial fibrillation or inexcitable tissue, the goal of AV synchrony cannot be met because the atria have no useful rhythm. VVI/R pacing is therefore the only option. VVIR is more desirable than VVI because patients who engage in even a moderate amount of activity benefit from rate response, especially when there is no chance for AV synchrony. Ventricular pacing is associated with adverse effects such as atrial fibrillation, stroke, congestive heart failure, and pacemaker syndrome (signs and symptoms of poor hemodynamics that result primarily from the loss of AV synchrony). These adverse effects exist in both VVI and VVIR patients, both at rest and during exercise. Therefore, even though ventricular pacing improves the quality of life in patients with an unstable atrium, it does not provide optimal pacing therapy. * * * CorePace Module 4: Troubleshooting * 双腔起搏器 三腔起搏器治疗心力衰竭 * 间隔部起博 * 缓慢性心律失常 预防房颤、预防和治疗长QT间期综合征的恶性室性心律失常（ICD) 辅助治疗肥厚梗阻型心肌病、扩张型心肌病、