常见心律失常的识别与处理.ppt

* * 室性早搏的治疗原则 良性室早 无症状 有症状 观察 抗心律失常药物 潜在恶性室早 积极治疗原发病 抗心律失常药物 * * 应紧急处理的室早 该类室早有可能演变为室速，室颤等致命性心律失常 急性冠脉综合征时出现的室早，尤其是频发，多源，短联律间期，成对成串的早搏 心肺复苏后出现的室早，正处于室速频繁发作期的室早，处于心功能急剧恶化时的室早。 心动过缓，抗心律失常药物，低血钾导致QT延长时出现的室早。 应首先改善心肌缺血，纠正心衰等原发因素，在此基础上可恰当的使用抗心律失常药物。静脉注射胺碘酮。 * * 室性心动过速 心电图特点：连续3个或3个以上的室性早搏；频率120-230次/分,无P波,节律规则。 患者可有心悸，心前区不适，胸闷，胸痛，乏力。 严重时可伴有血压下降，休克，心力衰竭，晕厥，可发生Adams-stroke综合征（阿-斯综合征） * * 室 速 * * 尖端扭转性室速 心电图特点：室性宽大QRS波群，振幅不断变化，基主波方向每隔3-10个心搏突然倒转，即围绕基线扭转，其波峰方向频率160-280次/分，Q-T间期最著延长，T波增宽、可高大或深倒置。 * * 室颤、室扑 心电图特点：心室扑动:正弦图形,波幅大而规整,频150~300 。 心室颤动:波形振幅与频率极不规则,频率150—500/minQRS波群-T完全消失. 临床表现?治疗 * * 室速的监护要点 应立即给予心电图及血压监测，迅速建立静脉通道。 观察患者生命体征及血流动力学是否稳定，将除颤器，利多卡因，胺碘酮，气管插管等急救设备在床旁备好。 观察患者有无头晕，意识淡漠，意识丧失或抽搐等阿斯综合征表现 静脉注射利多卡因，胺碘酮（观察） 如药物治疗无效且患者迅速出现血流动力学恶化，应立即给与直流电转复 * Speaker抯 Notes: This presentation was prepared by an electrophysiologist for use by Medtronic. It is the intent of this lecture to inform the participants on the complexities of the ICD system, the features available to help troubleshoot patient episodes, and to instill awareness of when an electrophysiologist consult is warranted. * Speaker抯 Notes: This presentation was prepared by an electrophysiologist for use by Medtronic. It is the intent of this lecture to inform the participants on the complexities of the ICD system, the features available to help troubleshoot patient episodes, and to instill awareness of when an electrophysiologist consult is warranted. * Speaker抯 Notes: This presentation was prepared by an electrophysiologist for use by Medtronic. It is the intent of this lecture to inform the participants on the complexities of the ICD system, the features available to help troubleshoot patient episodes, and to instill awareness of when an electrophysiologist consult is warranted. * Speaker抯 Notes: This presentation was prepared by an electrophysiologist for use by Medtronic. It is the intent of this lecture to inform the participants on the complexities of the ICD system,