急诊室如何处理心律失常研究生课.ppt

* The CHADS2 scheme is an amalgamation of the individual risk factors: Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, each of which is assigned one point, and prior Stroke of TIA which is given 2 points (hence, the subscript 2). The CHADS2 score system was designed to simplify the determination of stroke risk in general practice and is currently under validation. Using this system, the stroke rate per 100 patient-years without antithrombotic therapy is expected to increase by a factor of 1.5 for each 1-point increase from 1.9 for a score of 0, to 18.2 for the highest score of 6. Reference: 1. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285:2864-2870. * 6小时，合贝爽组即取得较好控制效果 * Diltiazem was administered at an initial bolus injection of 0.25 mg/kg over 2 minutes followed by a second bolus of 0.35 mg/kg if VR remained 90 bpm 15 minutes later, and then a maintenance infusion at 10 mg/hr for 24 hours. Digoxin was given at a bolus dose of 0.5mg, then 0.25 mg every 8 hours (i.e., 1.25 mg over 24 hours). This dosage is lower than the maximal recommended dose (1.5 mg over 24 hours) to adjust for the lower body weight (range, 40–60 kg) in our cohort of Chinese patients. Amiodarone was administrated at a loading infusion of 300 mg over the first hour followed by 10 mg/kg over 24 hours. This dosage is also lower than the maximal recommended dose (20 mg/kg over 24 hours) used for pharmacologic conversion of AF because this study was aimed to study the effect of amiodarone for VR control. 急诊室如何处理心律失常研究生课 血流动力学稳定的宽QRS心动过速 急诊室如何处理心律失常研究生课 血流动力学稳定规整宽QRS心动过速 持续单形室性心动过速 室上速伴差传（见室上速） 室上速伴预激旁路前传（见室上速） 急诊室如何处理心律失常研究生课 血流动力学稳定的宽QRS心动过速 在急诊情况下的诊断: ——病史：能否提供既往发作情况，是否与此次相同。以往的诊断考虑 ——12导联心电图和/或食管心电图：主要是寻找室房分离的证据 ——不要求作出十分精确的诊断。如果有困难，则以“宽QRS心动过速”诊断即可 急诊室如何处理心律失常研究生课 宽QRS心动过速诊断的常见误区 就图论图，忽略病史和体检 过多诊断SVT伴差传 ——医师在对宽QRS心动