心臟除顫
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心臟除顫[1](cardiac defibrillation[2][3])簡稱除顫(defibrillation)、去顫,是利用醫療器械、特定藥品、手術方式終止心臟顫動的治療方法。最常見的除顫是用電擊終止心房或心室纖顫,稱為電除顫(electric defibrillation)。
去顫對於危及生命的心律不整,如心室顫動、無脈性心室頻脈是一種常見的治療手段,常見的具體方法為使用去顫器(也稱除顫器)給予心臟治療劑量的電能。雖然原理目前尚未明瞭,但普遍認為這麼做能使極大部分的心肌去極化,終止心律不整,並使竇房結中的節律點能重建竇性心律。
電擊
[編輯]電除顫是使用一定強度的電流作用於心臟,電擊(shock)使全部或部分心肌除極後,心臟在自律性最高的起搏點重新主導心臟節律(通常是竇性心律)的方法。
心臟除顫器(cardiac defibrillator)又稱去顫電擊器、除顫器、去顫器,分為體外型、靜脈置入型、植入型,依不同需要使用[4]。
去顫實際上是將心臟電擊停跳,製造心臟停搏。心室顫動中心臟電信號活動紊亂,竇房結無法發出信號控制心臟有效進行血液循環,因此使用外部電流直接使得心臟停跳。停跳後,立刻進行CPR,以求竇房結自行恢復心跳。因此,對於已經心臟停搏的病人,是不進行電擊的,電擊了也是心臟停搏。僅對心律失常的病人電擊。
電復律與電除顫
[編輯]按原術語 electric cardioversion[5][6](電復律)與 electric defibrillation[7][8](電除顫)意思,前者是使心律失常恢復至正常節律,後者是終止心臟顫動(心房顫動、心室顫動);因此電除顫屬於一種電復律。但在臨床上,英語與漢語都有混用的情形,合稱復律除顫(cardioversion-defibrillation[9]);或是更常將「電復律」等義於同步電復律,儘管所謂「電復律」也用於治療心房顫動;而「電除顫」等義於非同步電復律,儘管所謂「電除顫」治療的疾病不一定是心臟顫動的情況,而可能是無脈性室速[10][11][12]。
- 同步電除顫(synchronized defibrillation[13])或同步電復律(synchronized electroversion[14]/cardioversion[15]),是心電圖上能檢測到心室波(R波)進行的電除顫,適用於心房顫動、心房撲動、室上性心動過速、室性心動過速等快速心律失常[16]。
- 非同步電除顫(unsynchronized defibrillation[17])或非同步電復律(unsynchronized electroversion/cardioversion[18]),是心電圖上不能檢測到心室波(R波),在任意時刻用強脈衝放電使所有心肌纖維同時除極的過程,適用於心室顫動、心室撲動時[19]。
心臟復律除顫器(cardioverter-defibrillator)又稱復律除顫器,是具有支持性起搏和抗心動過速起搏,且能自動感知與識別室性心動過速或心室顫動發作,並立即放電進行低能量復律或高能量除顫等作用的裝置[20][21]。
藥物
[編輯]藥物除顫:
心導管手術
[編輯]手術除顫:
- 心導管射頻燒灼術(Radiofrequent catheter ablation;RFCA)[22]
- 熱氣球導管
另見
[編輯]- 自動體外心臟去顫器(AED)
參考文獻
[編輯]- Picard, André. School defibrillators could be a lifesaver. The Globe and Mail. 2007-04-27 [2015-07-23]. (原始內容存檔於2020-12-22).
外部連結
[編輯]- Sudden Cardiac Arrest Foundation(頁面存檔備份,存於網際網路檔案館)
- Center for Integration of Medicine and Innovative Technology(頁面存檔備份,存於網際網路檔案館)
- American Red Cross: Saving a Life is as Easy as A-E-D (頁面存檔備份,存於網際網路檔案館)
- FDA Heart Health Online: Automated External Defibrillator (AED)(頁面存檔備份,存於網際網路檔案館)
- Resuscitation Council (UK)(頁面存檔備份,存於網際網路檔案館)
- How an internal defibrillator is implanted from Children's Hospital Heart Center, Seattle.
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- ^ 心脏除颤. 術語在線. 全國科學技術名詞審定委員會. (簡體中文)
- ^ 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 , 編. The Textbook of Emergency Cardiovascular Care and CPR. Lippincott Williams & Wilkins. 2009: 363. ISBN 9780781788991.
- ^ What is the LifeVest?. Zoll Lifecor. [2009-02-09]. (原始內容存檔於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
(英語).
- ^ 認識心臟電氣生理檢查與心導管射頻燒灼術 (PDF). 台灣醫院. [2020-10-07]. (原始內容存檔 (PDF)於2020-10-09).