常见心律失常.pptVIP

多形性室速分：QT间期延长与非QT间期延长； QT延长伴多形性室速为尖端扭转性室速； 胺碘酮不应用于伴QT延长的扭转型室速； 患者就诊即是室速而无机会展示是否为伴长QT间期，难于抉择，主张DC。 * * * * * The incidence of VF occurring within 48 h of the onset of STEMI may be decreasing owing to increased use of reperfusion treatment and b-blockers. VF occurring early after STEMI has been associated with an increase in in-hospital mortality, but not with increased long-term mortality. The major determinants of risk of sudden death are related more to the severity of the cardiac disease and less to the frequency or classification of ventricular arrhythmias. Use of prophylactic b-blockers in the setting of STEMI reduces the incidence of VF. Similarly, correction of hypomagnesaemia and hypokalaemia is encouraged because of the potential contribution of electrolyte disturbances to VF. Prophylaxis with lidocaine may reduce the incidence of VF but appears to be associated with increased mortality probably owing to bradycardia and asystole, and has therefore been abandoned. In general, treatment is indicated to prevent potential morbidity or reduce the risk of sudden death. There is no reason to treat asymptomatic ventricular arrhythmias in the absence of such potential benefit. 室性早搏 R on T现象 室性期前收缩 一、病因 可发生于正常人，亦可发生于各种病理状态。 二、临床表现 无特异性。 三、心电图特点 1. 提前出现QRS，宽大畸形，ST-T与主波方向相反； 2. 配对间期恒定； 3. 代偿间歇完全； 四、治疗 1. 无器质性心脏病 无需治疗； 2. 急性心肌缺血 仅在出现以下情况时应用抗心律失常药物：频发室早；多源性室早；R on T；成对或连续室早。首选药物为利多卡因，β受体阻滞剂可有效减少恶性心律失常发生率。 3. 慢性心脏病变 避免使用I类抗心律失常药；β受体阻滞剂和胺碘酮可以有效减少猝死发生率。 尖端扭转型室性心动过速 一、病因: 最常见于器质性心脏病如冠心病心肌梗死；偶见于无器质性心脏病患者. 二、临床表现: 原发病表现 症状与室性心动过速持续时间有关: 持续性室性心动过速(发作时间超过30秒)→血流动力学异常及心肌缺血 非持续性室性心动过速→一般无症状 三、心电图特点 1. 3个或以上室早连续出现； 2. QRS波群宽大畸形，ST-T与主波方向相反； 3. 心室率100～250bpm； 4. 房室分离，偶有心房夺获； 5. 突发突止； 6. 心室