室颤和心脏除颤英文.pptxVIP

室颤和心脏除颤英文第1页/共27页 第2页/共27页 Wiggers VI stage VFWiggers CJ, Am Heart J 5:351, 1930Undulatory Stage Convulsive Stage Tremulous Stage Atonic Stage 1-2’’ 10-20’’ 2-4’ 2-5’第3页/共27页 Epicardial Activation during VF第4页/共27页 Huang J. et al. Am J Physiol 2004; 286:H1193第5页/共27页 第6页/共27页 Jian Huang et al. Am J Physiol 2004; 286:H1193第7页/共27页 Jian Huang et al. Am J Physiol 2004; 286:H1193第8页/共27页 Jian Huang et al. Am J Physiol 2004; 286:H1193第9页/共27页 J. Huang et al. Am J Physiol 2004; 286:H1193第10页/共27页 J. Huang et al. Am J Physiol 2004; 286:H1193第11页/共27页 Type I and Type II VFType I VFAPDR cause instabilities (steep APDR)Normal exitabilityMultiple waveletsType II VFFlat APDRLow exitabilityBroad conduction velocity (CV) restitution promotes instabilites Spatiotemporal periodicity with intermittent wavebreaks第12页/共27页 3-Phase Time-Sensitive ModelThe electrical phase (0-4 min)Defibrillation Class I recommendation from ILCOR8%-10% decreased survival rateICD vs Amiodarone trialsThe circulaotry phase (4-10 min)Immediately shock 30% successful defibrillation, 0% return of spontaneous circulation.1 min CPR + epinephrine before shock 70% successful defibrillation and 40% return spontaneous circulation.CPR – partial restoration of substrates including O2 or washout of deleterious metablic factorsThe metabolic phase (after 10 min)The effectiveness of both immediate shock or CPR followed by shock are poor.It is unknown whether irreversible injury occurs or whether therapeutic approaches fail to correct important factor 第13页/共27页 第14页/共27页 第15页/共27页 EPIEndo第16页/共27页 P1 (4, 5)第17页/共27页 P1 (3, 4)第18页/共27页 Successful Defibrillation ShockEnough strength of energy Not too lowNot too highOptimal waveform Optimal lead configurationExtinguish most of VF activation frontWithout creating an environment that promotes susceptibility to reinitiation of fibrillation 第19页/共27页 Monoph