心脏除颤
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心脏除颤[1](cardiac defibrillation[2][3])简称除颤(defibrillation)、去颤,是利用医疗器械、特定药品、手术方式终止心脏颤动的治疗方法。最常见的除颤是用电击终止心房或心室纤颤,称为电除颤(electric defibrillation)。
去颤对于危及生命的心律不整,如心室颤动、无脉性心室频脉是一种常见的治疗手段,常见的具体方法为使用去颤器(也称除颤器)给予心脏治疗剂量的电能。虽然原理目前尚未明了,但普遍认为这么做能使极大部分的心肌去极化,终止心律不整,并使窦房结中的节律点能重建窦性心律。
电击
[编辑]电除颤是使用一定强度的电流作用于心脏,电击(shock)使全部或部分心肌除极后,心脏在自律性最高的起搏点重新主导心脏节律(通常是窦性心律)的方法。
心脏除颤器(cardiac defibrillator)又称去颤电击器、除颤器、去颤器,分为体外型、静脉置入型、植入型,依不同需要使用[4]。
去颤实际上是将心脏电击停跳,制造心脏停搏。心室颤动中心脏电信号活动紊乱,窦房结无法发出信号控制心脏有效进行血液循环,因此使用外部电流直接使得心脏停跳。停跳后,立刻进行CPR,以求窦房结自行恢复心跳。因此,对于已经心脏停搏的病人,是不进行电击的,电击了也是心脏停搏。仅对心律失常的病人电击。
电复律与电除颤
[编辑]按原术语 electric cardioversion[5][6](电复律)与 electric defibrillation[7][8](电除颤)意思,前者是使心律失常恢复至正常节律,后者是终止心脏颤动(心房颤动、心室颤动);因此电除颤属于一种电复律。但在临床上,英语与汉语都有混用的情形,合称复律除颤(cardioversion-defibrillation[9]);或是更常将“电复律”等义于同步电复律,尽管所谓“电复律”也用于治疗心房颤动;而“电除颤”等义于异步电复律,尽管所谓“电除颤”治疗的疾病不一定是心脏颤动的情况,而可能是无脉性室速[10][11][12]。
- 同步电除颤(synchronized defibrillation[13])或同步电复律(synchronized electroversion[14]/cardioversion[15]),是心电图上能检测到心室波(R波)进行的电除颤,适用于心房颤动、心房扑动、室上性心动过速、室性心动过速等快速心律失常[16]。
- 异步电除颤(unsynchronized defibrillation[17])或异步电复律(unsynchronized electroversion/cardioversion[18]),是心电图上不能检测到心室波(R波),在任意时刻用强脉冲放电使所有心肌纤维同时除极的过程,适用于心室颤动、心室扑动时[19]。
心脏复律除颤器(cardioverter-defibrillator)又称复律除颤器,是具有支持性起搏和抗心动过速起搏,且能自动感知与识别室性心动过速或心室颤动发作,并立即放电进行低能量复律或高能量除颤等作用的装置[20][21]。
药物
[编辑]药物除颤:
心导管手术
[编辑]手术除颤:
- 心导管射频烧灼术(Radiofrequent catheter ablation;RFCA)[22]
- 热气球导管
另见
[编辑]- 自动体外心脏去颤器(AED)
参考文献
[编辑]- Picard, André. School defibrillators could be a lifesaver. The Globe and Mail. 2007-04-27 [2015-07-23]. (原始内容存档于2020-12-22).
外部链接
[编辑]- Sudden Cardiac Arrest Foundation(页面存档备份,存于互联网档案馆)
- Center for Integration of Medicine and Innovative Technology(页面存档备份,存于互联网档案馆)
- American Red Cross: Saving a Life is as Easy as A-E-D (页面存档备份,存于互联网档案馆)
- FDA Heart Health Online: Automated External Defibrillator (AED)(页面存档备份,存于互联网档案馆)
- Resuscitation Council (UK)(页面存档备份,存于互联网档案馆)
- How an internal defibrillator is implanted from Children's Hospital Heart Center, Seattle.
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- ^ Bubien RS, Ching EA, Kay GN. Cardiac defibrillation and resynchronization therapies: principles, therapies, and management implications. AACN Clin Issues. 2004;15(3):340-361. doi:10.1097/00044067-200407000-00004
- ^ Endre Zima. Updates on Cardiac Defibrillation, Cardioversion and AED Development. BoD – Books on Demand. 2024. ISBN 9781837686070.
- ^ Jolley, Matthew; Stinstra, Jeroen; Pieper, Steve. A Computer Modeling Tool for Comparing Novel ICD Electrode Orientations in Children and Adults. Heart Rhythm. 2008, 5 (4): 565–572. PMC 2745086
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- ^ Cardioversion. British Heart Foundation.
- ^ Prasai P, Shrestha DB, Saad E, Trongtorsak A, Adhikari A, Gaire S, Oli PR, Shtembari J, Adhikari P, Sedhai YR, Akbar MS, Elgendy IY, Shantha G. Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Feb 1;12(3):1165. doi: 10.3390/jcm12031165. PMID: 36769812; PMCID: PMC9918032.
- ^ Negovsky VA, Gurvich NL, Tabak VY, Bogushevich MS. The nature of electric defibrillation of the heart. Resuscitation. 1973 Dec;2(4):255-9. doi: 10.1016/0300-9572(73)90030-0. PMID: 4793522.
- ^ He Q, Wan Z. [History of electric defibrillation]. Zhonghua Yi Shi Za Zhi. 2007 Jul;37(3):161-4. Chinese. PMID: 18453207.
- ^ L. Brent Mitchell. Direct Current (DC) Cardioversion-Defibrillation. MSD Manual Professional Version.
- ^ Synchronized And Unsynchronized Cardioversion. Learn and Master ACLS/PALS.
- ^ J. Lee West. Defibrillation/Cardioversion TSRA Primer - Critical Care. the American Association for Thoracic Surgery.
- ^ Rohit R. Gupta; Ylaine Rose T. Aldeguer. Critical Care Chapter 92: Cardioversion and Defibrillation. McGraw-Hill Education. 2017. ISBN 978-0-07-182081-3.
- ^ Darragh KM, Manoharan G, Navarro C, Walsh SJ, Allen JD, Anderson JM, Adgey AJ. Synchronized defibrillation for ventricular fibrillation. Eur Heart J Acute Cardiovasc Care. 2012 Dec;1(4):285-90. doi: 10.1177/2048872612458498. PMID: 24062919; PMCID: PMC3760569.
- ^ Sai-Ching Jim Yeung; Carmen P. Escalante. Oncologic Emergencies. PMPH-USA. 2002: 308. ISBN 9781550091717.
- ^ https://acls.com/articles/about-synchronized-cardioversion/
- ^ Rüdiger Kramme; Klaus-Peter Hoffmann, Robert Steven Pozos. Springer Handbook of Medical Technology. Springer Science & Business Media. 2011: 549. ISBN 9783540746584.
- ^ https://www.ahajournals.org/doi/full/10.1161/circ.102.suppl_1.I-90
- ^ https://perfusion.com/synchronized-vs-unsynchronized-cardioversion/
- ^ American College of Emergency Physicians; American Heart Association. John M. Field , 编. The Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins. 2009: 363. ISBN 9780781788991.
- ^ What is the LifeVest?. Zoll Lifecor. [2009-02-09]. (原始内容存档于2008-11-21).
- ^ Adler, Arnon; Halkin, Amir; Viskin, Sami. Wearable Cardioverter-Defibrillators. Circulation. 2013-02-19, 127 (7): 854–860. ISSN 0009-7322. PMID 23429896. doi:10.1161/CIRCULATIONAHA.112.146530
(英语).
- ^ 認識心臟電氣生理檢查與心導管射頻燒灼術 (PDF). 台湾医院. [2020-10-07]. (原始内容存档 (PDF)于2020-10-09).