心律失常 -全面讲解精编版.ppt

起搏系统 起搏器置入过程 局部麻醉 经静脉放置起搏导线和测试 制作囊代、置入起搏器 手术过程只需1小时！ 快速心律失常的非药物治疗 心脏电复律，ICD植入 快速性心律失常的非药物治疗 导管射频消融治疗快速性心律失常 总 结 心律失常是心内科常见多发疾病，但其理解和掌握 有一定 一定困难，要长期的临床-实践-再实践，结合心电图识读 改善血流动力学是最重要的目标 重视基础疾病和诱发因素的处理 正确选择和应用抗心律失常药物 提倡使用电复律等器械治疗 关注安全性，权衡风险与效益 积分≥3分时提示“高危”，出血高危患者无论接受华法林还是阿司匹林治疗，均应谨慎，并在开始抗栓治疗之后定期复查 aHypertension’ is defined as systolic blood pressure .160 mmHg. ‘Abnormal kidney function’ is defined as the presence of chronic dialysis or renal transplantation or serum creatinine ≥200 mmol/L. ‘Abnormal liver function’ is defined as chronic hepatic disease (e.g. cirrhosis) or biochemical evidence of significant hepatic derangement (e.g. bilirubin胆红素 .2 x upper limit of normal, in association with转氨酶 aspartate aminotransferase/alanine aminotransferase/alkaline phosphatase .3 x upper limit normal, etc.). ‘Bleeding’ refers to previous bleeding history and/or predisposition to bleeding, e.g. bleeding diathesis, anaemia, etc. ‘Labile INRs’ refers to unstable/high INRs or poor time in therapeutic range (e.g. ,60%). Drugs/alcohol use refers to concomitant use of drugs, such as antiplatelet agents, non-steroidal anti-inflammatory drugs, or alcohol abuse, etc. * The pacing system includes an implantable pulse generator (IPG), lead, and programmer. The IPG is the battery source and programmable electrical impulse generator. The IPG can be programmed noninvasively using radiofrequency signals from an external programmer. Connected to the IPG is the lead, which is a small cable with an electrode. The lead delivers electrical stimulation to the myocardium and senses electrical signals generated by the heart. The slide shows the basic steps for implanting a pacing system. Each step is shown in more detail in the next several slides. 手术过程大约1-2小时，病人住院1-6天。无需开胸。 心房颤动室率控制的药物应用 合并心衰： 静脉胺碘酮： 静脉负荷，5mg/kg静注30-60min（不要快！） 然后以50mg/h持续静滴，室率控制后可直接停药 心房颤动室率控制的药物应用 合并心衰： 洋地黄制剂：毛花苷C（西地兰） 未口服用洋地黄者0.4-0.4mg莫滴 效果不好可在2小时后再给0.2mg，最大1.2mg 若已经口服地高辛，第一剂一般给0.2mg，以后酌情是否再