心脏复苏解决方案课件.ppt

心脏复苏解决方案

一个电生理事件…刺激一个机械事件…主要的泵血瓣膜…结果是协调了心脏的泵血和有规律的脉搏健康的心脏一连串的事件

AHeartinDistress突发心脏骤停不协调的,很快的心脏节律心室纤维颤动(VF室颤)一部分室性心动过速(VT室速)无效的心脏泵血无意识，无呼吸不进行除颤会死亡

StereotypeRealityMaleOldOverweightSmokerHighcholesterolChestPainDizzinessHeartAttackMaleandFemaleAnyAgeOftenNoClearRiskFactorsOftenNoCardiacHistoryOftenNoSymptomsGenderAgeRisk

FactorsMedicalHistoryPresentingSymptomsSCAFictionvs.Fact

什么是除颤？对心脏的电击停止不协调的节律容许恢复正常节律和脉搏室颤最权威性的治疗手段

颤动除颤转复成功

什么是除颤器？ADefibrillator…de-Fibrillatesafibrillatingheart,bysendaelectricshockofsufficientdosagemethodofdelivery,thatcausesrandomactiontostop,toallowthenormalheart-controltotakebackcontrol.ITDOESNOTRE-STARTtheHeartFundamentallyitterminatesVentricularFibrillation.

能量和波形水桶模型电容器能量电压伏特电流病人阻抗电容=水桶能量=储水量电压=水面高度(压力)电流=水流阻抗=流动阻力电容能量电压电流阻抗CEVIR微法(μF)焦尔(J),或瓦特秒伏特(V)安培(A)欧姆(W)术语符号测量单位

能量(E)、电压和电流电压(V)、电流(I)和阻抗(R)能量和波形V=IRVxI=P 电压x电流=功率(瓦特)Pxt=Energy 功率x时间=能量(焦尔或瓦特秒)电流由初始电压和病人阻抗*决定 V=IR;I=V/R 电压=电流x阻抗；电流=电压/阻抗欧姆定律*阻抗由身体组织形成：表皮、毛发、脂肪、骨骼和胸壁内空气，一般为70-80ohm

TheStandardProtocol-单相波接连发放200J,300J,360J的能量(儿童2J/公斤)大部分现在的除颤器使用单相正弦衰减波或单相截顶指数波没有任何的研究证据支持Theworldhasaccepteditduetoitshistoricaluse.BasedonAHAclassificationofscientificevidence…thisratesaLevel8evidence,thelowestavailable.假定50ohm经胸阻抗来发放电流AllmanufacturesincludingAgilent/HP/Physio/NK…makeanassumption!!!!GOLD“AreviewofpreviousAHAguidelinesfortheenergysequence200J-300J-360Jrevealsthattheevidencesupportingthisreputed“goldstandard”islargelyspeculative….”Cummins,R.O.etal.Circulation1998;97:1654-1667

TheStandardProtocolTodaythegoldstandardhasbeenchallenged…

AHAhassinceacknowledgedthegrowingbodyofevidenceandmadeourSMARTBiphasictheonlytherapytoreceiveLevelIIaclassificationChallengingtheacceptednorms…practicingevidencebasedmedicineGOLD

Waveforms,theprescriptionforElectricm