心律失常大课件.pptVIP

抗心律失常药物（1） Ⅰ类：阻滞Na+通道 Ⅰa：奎尼丁、普鲁卡因胺（APD?） Ⅰb：利多卡因、慢心律（APD?） Ⅰc：心律平、氟卡尼（APD?） Ⅱ类：?-Blocker， Ⅲ类：K+通道阻滞剂：胺碘酮 Ⅳ类：CCB：异博定 心律失常的治疗:副作用 药物 副 作 用 利多卡因 眩晕，感觉异常，意识模糊，谵妄，昏迷；心脏方面：少数引起窦房结抑制，室内传导阻滞。 美西律 恶心，呕吐，运动失调，震颤，步态障碍，皮疹； 心脏方面：低血压，心动过缓，心律失常加重。 胺碘酮 肺纤维化，转胺酶升高，角膜色素沉着，甲亢和甲状腺功能减退，发生尖端扭转行室速 普罗帕酮 窦房结抑制，房室阻滞，加重心力衰竭 普萘诺尔 低血压，心动过缓，充血性心力衰竭，心绞痛患者突然撤药引起症状加重，心律失常 维拉帕米 低血压，心动过缓，房室阻滞， 禁用于：严重心力衰竭，二，三度房室阻滞 AAD合理应用 1.首先注意基础心脏病的治疗以及病因和诱因的纠正； 2.注意掌握抗心律失常药物的适应征，并非所有的心律失常 均需应用抗心律失常药物，众多无明显预后意义的心律失常一般不需要抗心律失常药物治疗； 3.注意抗心律失常药物的不良反应，包括对心功能的影响， 致心律失常作用和对全身其他脏器与系统的不良作用。 心律失常的介入治疗和手术治疗 ☆心脏电复律 ☆心脏起搏治疗缓慢性心律失常 ☆导管射频消融治疗快速性心律失常 ☆快速性心律失常的外科治疗 谢谢!! Atrial fibrillation can also result from the rapid discharge of impulses from one or many ectopic (non-sinus) sites in the atria. The ectopic cells (called foci) depolarize independently of the sinus node and disrupt the normal sinus rhythm. Multifocal firing takes place at multiple atrial ectopic sites. The cells produce many depolarization waves that activate different areas of the atrial myocardium at different times. AF occurs because the myocardial cells do not contract and relax rhythmically, in normal synchronization with the sinus node. *Note: Because a mechanism of AF may be Mulifocal Firing, some would argue that AF is a disorder of Impulse Formation (abnormal automaticity), rather than Impulse Conduction (multiple wavelets of reentry). Some argue still that while ectopic or mulifocal firing may begin AF, it is reentry that sustains it. For purposes of laying out rhythm disorders in this presentation, AF has been identified as a disorder of Impulse Conduction due to how it is sustained. May it be understood, however, that it could arguably be classified under both disorder descriptions. WPW is characterized by: Short PR interval (120 ms or less) indicating that the impulse did not travel the path through the AV Node. QRS is wide (110 ms or greater) again implying the impulse did not trav