心律失常紧急处理专家共识2013课件.pptVIP

起搏方法： 经皮起搏：将两个特制电极片粘贴于心尖部和右胸上部，也可粘贴于前后胸部。连接具有起搏功能的除颤器。此法操作简单 一般需数十伏电压才可起搏成功，常不能完全夺获心室。只可作为紧急情况下或等待经静脉起搏的过渡措施 患者有疼痛不适，难以耐受 经静脉起搏： 起搏可靠，患者痛苦小。可在床边或X线指导下操作 采用经皮穿刺法经颈静脉、锁骨下静脉或股静脉置入临时起搏电极，将电极尖端置于右室心尖部，尾端与临时起搏器相联 选择适当起搏频率和电压（电流）起搏。 颈静脉或锁骨下静脉途径利于固定，但穿刺技术要求较高 股静脉途径操作简单，不利于长期保留，可出现下肢并发症 可保留数日，但要防止感染、血栓等。应酌情抗感染、抗凝 经食管电极起傅：见前述 电复律术 适应症 非同步电复律 适用于心室颤动/无脉室性心动过速的抢救和某些无法同步的室性心动过速。 同步直流电转复 适用于心房颤动、 阵发性室上性心动过速、 阵发性室性心动过速， 尤其适用于伴心绞痛、心力衰竭、血压下降等血液动力学障碍及药物治疗无效者。 谢 谢 * 室上性心动过速应与其他快速心律失常鉴别，如心房扑动伴2:1房室传导。在II、V1导联寻找房扑波（F波）的痕迹有助于诊断。食管导联心电图可见呈2:1房室传导的快速心房波，对心房扑动的诊断有较大帮助。当AVRT表现逆向折返或室内阻滞时可表现为宽QRS波心动过速，易与室性心动过速混淆，参考平时窦性心律心电图可有帮助。 * * 首先可采用刺激迷走神经方法。深吸气后屏气同时用力做呼气动作（Valsalva法），或用压舌板等刺激咽喉部产生恶心感，可终止发作。压迫眼球或按摩颈动脉窦现已少用。刺激迷走神经方法仅在发作早期使用效果较好。 * * 大多数房颤患者经过数年，由偶尔发作，变为频繁、持续时间延长至变为持续性房颤。只有很少的比例（2%-3%）患者若干年后仍为阵发房颤 * * Patients with AF therefore represent a vast population at high risk of stroke and, in particular, severe stroke. These patients are an important target population for reducing the overall burden of stroke. To prevent AF-related stroke, the ideal would be to prevent of reverse AF itself. Current techniques can only prevent AF in some patient. Hence, there is a clear need to improve detection and therapy of AF. For stroke prevention in AF the guideline-recommend the use of anticlotting drug therapy also known as anticoagulation therapy such as Aspirin and/or vitamin k antagonists. The type of anticoagulation therapy depends on the individual patient’s magnitude of risk. Various schema are available for evaluating stroke risk in AF, CHADS2 being the scheme probably used most frequently in routine practice. A cumulative CHADS2 score (range 1 to 6) is calculated by assigning points, and risk assessed accordingly, as shown in the slide. The current guidelines recommend Aspirin for patients at low risk, Aspirin or vitamin k antagonists for patients at moderate risk, and vitamin k antagonists for patients at moderate-to-high risk of stroke REFER