高危辅助策略ppt课件.ppt

心律失常 心腔内放置任何导管均可能诱发心律失常。 最常见的是室性异位心律，应将导管电极游离在心腔中，停止操作片刻，待完全消失后再继续进行；若仍频发，应静注利多卡因等抗心律失常药物预防治疗。 并发症 穿刺感染 局部处理不妥或电极导管放置时间过长， 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。 穿刺并发症 此类并发症直接与术者的经验有关。 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%） 。 而选择颈内静脉入路， 气胸的发生率为 1 %， 误穿刺动脉略为常见一些， 约3%。 股静脉穿刺则多伴发静脉血栓（25%～35%） 及感染（5%～10%） 。 并发症 心脏临时起搏是一项简单而适用的方法， 具有省时、 迅速、 简单易行的特点， 为具有心律失常潜在危险的患者施行手术提供了安全、 保护性的措施， 心内介入医师应该熟悉临时起搏器的应用和注意事项， 在围术期中发挥应有的作用。 Pinch me, I think I am dreaming...PCI is finished...Magic Bullit....We really save him again! Get another Job! Thank you,doctor… * * There was marked international variation in cardiogenic shock survival and IABP use. In those countries with the lowest percentage use of IABP in cardiogenic shock, mortality was the highest. i.e. Germany, IABP use was 2% in cardiogenic shock with a mortality of 69% versus the US where IABP use was 36% with a mortality of only 50%. These results support increased utilization of IABP therapy in cardiogenic shock. * * Recommendations during pressure monitoring through the central lumen: Before Pumping: 1. Use a standard flushing apparatus. Careful technique should be used in the set up and flushing of the arterial pressure monitoring apparatus to minimize the risk of an embolus. 2. Minimize the length of pressure tubing. 3. Use only high stiffness pressure tubing [as provided by Datascope or Abbott] 4. Aspirate and discard 3cc of blood from the central lumen prior to attaching pressure tubing. 5 Immediately manually flush with 3-5 cc of flush solution prior to attaching the pressure tubing for arterial monitoring. During Pumping: 1. Do not sample blood from the central lumen. 2. If the central lumen becomes damped: ? aspirate discard 3cc of blood ? fast flush to clear the pressure tubing ? continue to flush once the pressure tubing is clear for at least 15 seconds. * * An editorial comment from Marie Claude Morice reviewed recent publications on the clinical imp