philips除颤讲解1.pptVIP

心脏复苏解决方案 凌岚岚 产品专员 心电产品市场部 健康的心脏 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 SCA Fiction vs. 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 什么是除颤器？ A Defibrillator… de-Fibrillates a fibrillating heart, by send a electric shock of sufficient dosage method of delivery, that causes random action to stop, to allow the normal heart-control to take back control. IT DOES NOT RE-START the Heart Fundamentally it terminates Ventricular Fibrillation. 能量和波形 能量和波形 The Standard Protocol- 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 The world has accepted it due to its historical use. Based on AHA classification of scientific evidence… this rates a Level 8 evidence, the lowest available. 假定50 ohm经胸阻抗来发放电流 All manufactures including Agilent/ HP/ Physio/ NK… make an assumption!!!! The Standard Protocol Today the gold standard has been challenged…AHA has since acknowledged the growing body of evidence and made our SMART Biphasic the only therapy to receive Level IIa classification Challenging the accepted norms… practicing evidence based medicine Waveforms, the prescription for Electric medicine Just as medications are prescribed Dosage : Quantity of Energy Time : dosing schedule Method : route of delivery Defibrillation energy is delivery at a specific energy dosage, over a specific time, through a specific waveform 除颤之外… 是否恢复正常泵血则由心肌细胞功能决定 Defibrillator device stops fibrillation… 所有技术都强调对心脏的电击 很少考虑到能量大小以及释放能量的方法能够影响到心肌细胞恢复正常功能的可能性 Tradition vs Future 除颤波形 What is SMART Biphasic 150-150-150J 不递增除颤能量序列 阻抗补偿 (25?-180?) 智能双相截顶指数波 (generated by 100?F capacitor) 根据阻抗调节持续时间，总持续时间 = 20ms SMART Biphasic Waveform 波形形态 心脏电击治疗 除颤需要足够的电流流过心脏——经心电流（transcardiac current） 当电流流过心脏时将能量释放给心脏 心脏电击治疗 只有5%的除颤电流可以通过心脏 1！ 其余的电流被分流了 没有向心脏释放能量 心脏电击治疗 分流情况随病人而定 病人胸部阻抗越小，分流越多 除颤器设计时必须满足 提供更多的除颤电流给低阻抗病人 分流电流变化小，而经心电流变化大 Why SMART Biphasic? Better 长时间VF首次除颤成功率 Better 神经功能 Better 除颤后心功能… than any othe