最新心外_临时起搏器PPT课件.ppt
心外心外_临时起搏器临时起搏器人工心脏起搏是用人工脉冲电流刺激心脏以启动心搏，从而代替心脏自身起搏点，主要用于治疗缓慢性心律失常，也用于抑制快速性心律失常。若心肌已丧失兴奋收缩特性，则起搏无效。The 1987 NASPE/BPEG Generic(NBG)Pacemaker CodePositionIIIIIIIVVCategory:Chamber(s)pacedChamber(s)sensedResponse(s)to sensingProgram-mability,rate modulationAntitachy-arrhythmia function(s)O=NoneA=AtriumV=VentricleD=Dual(A+V)O=NoneA=AtriumV=VentricleD=Dual(A+V)O=NoneT=TriggeredI=InhibitedD=Dual(T+I)O=NoneP=Simpleprogram-mableM=Multi-program-mableC=Communi-catingR=Rate modulationO=NoneP=Pacing(anti-tachyarrhyth-mia)S=ShockD=Dual(P+S)Manufac-turersdesignation only:S=Single(A or V)S=Single(A or V)Note:Positions I through III are used exclusively for antibradyarrhythmia function.The NASPE/BPEG Generic(NBG)Pacemaker Code(Revised 2000)PositionIIIIIIIVVCategory:Chamber(s)pacedChamber(s)sensedResponse to sensingRate modulationMultisite pacingO=NoneA=AtriumV=VentricleD=Dual(A+V)O=NoneA=AtriumV=VentricleD=Dual(A+V)O=NoneT=TriggeredI=InhibitedD=Dual(T+I)O=NoneR=Rate modulationO=NoneA=AtriumV=VentricleD=Dual(A+V)Mfrdesignation only:S=Single(A or V)S=Single(A or V)起搏器分类非同步起搏器同步起搏器P波同步R波同步顺序起搏器程控型起搏器单腔起搏器双腔起搏器临时起搏器（体外携带式）永久起搏器（体内埋藏式）起搏治疗适应征（临时起搏器）起搏时间在4周以内急性心肌炎引起的度、度房室传导阻滞并阿斯综合征发作，药物治疗无效者急性心肌梗死并高度或完全性房室传导阻滞致心动过缓药物中毒，电解质紊乱所致心脏阻滞心脏手术后可能系水肿、炎症所致的完全性房室传导阻滞有高度房室传导阻滞或窦房结功能不全患者，外科手术期间保护性应用起搏治疗适应征（永久起搏器）伴有症状的病态窦房结综合征完全性房室传导阻滞伴阿斯综合征双束支或三束支传导阻滞，症状明显者手术损伤传导系统引起不可逆性房室传导阻滞药物治疗无效、反复发作的快速性心律失常，顽固性快速心律失常三腔起搏器治疗扩张型心肌病充血性心衰起搏器植入方法1.经静脉心内膜起搏2.静脉外起搏法体表胸壁起搏经胸壁穿刺心内膜起搏食管心脏起搏心外膜起搏现用起搏器Medtronic5348单腔临时起搏器OsykpaPACE101HMedtronic5348安全特性系统自检低电量提示（24h）替换电池时可连续操作80ppm10mA15秒可颠倒的电池电极受保护的控制面板及导线接口安全的关机操作Medtronic5348安全特性快速心房起搏处的提醒标志频率和灵敏度拨盘上的高亮标记和拨动限制抗击360ws的除颤能量静电保护在电磁环境中保证受干扰程度最小安全的中继线Medtronic5348性能参数Modes：VVI，VOO，AAI，AOOBasicPacingRates：30180ppmcontinuouslyadjustableRapidAtrialPacingRates：80380ppm（5ppmincrements）380540ppm（10ppmincrements）540800ppm（20ppmincrements）OutputAmplitude：0.120mAcontinuouslyadjustablePulseWidth：1.8msMedtronic5348性能参数Sensitivity：0.520mVcontinuouslyadjustable，ASYNCRefractory：250msDimensions：18.8x6.1x4.1cm(7.4x2.4x1.6inches)283gm(10oz.)withbatteryBatteryType：Standard9V，AlkalineorLithiumBatteryLifeatnominalsettingsandtypicalconditions：Alkaline：300hoursLithium：650hours现用起搏器Medtronic5388双腔临时起搏器Medtronic5388性能参数Modes:DDD,DDI,DVI,DOO,AAI,AOO,VVI,VOOBasePacingRate:30-200ppmUpperRate:80-230ppmRapidAtrialPacingRate:80-800ppmOutputAmplitudeAtrial:0.1-20mAVentricular:0.1-25mAPulseWidthAtrial:1.0msVentricular:1.5msMedtronic5388性能参数SensitivityAtrial:0.4-10mV,async.Ventricular:0.8-20mV,async.A-VInterval:20-300msRefractoryPeriodAtrial:150-500msVentricular:250msVentricularBlankingPace:125msSense:75msDimensions21.1x8.1x3.6cm(8.3x3.2x1.4in.)510g(18oz.)withbatteryBatteryType:Standard9V,AlkalineorLithiumBatteryLifeAlkaline:9daystypicalLithium:16daystypical起搏器参数调节成人：90100ppm婴幼儿：120140ppm起搏频率设定儿童：100120ppm起搏器参数调节起搏阈值：每次都能引起心脏起搏的最小电压或电流。将电压和电流逐渐降低使起搏心电图有漏搏，再增大电压和电流致出现连续有效起搏的电压和电流即为起搏阈值。一般起始阈值：电压0.5V，电流0.71.0mA设定工作输出应为阈值的2倍电压1.0V，电流1.5mA*心脏外科监护：起搏阈值35mA或1.53V，设定电压36V起搏器参数调节感知灵敏度：感知过高会将T波误感为P波或R波，导致起搏脉冲受抑制而不起搏；感知过低则不能识别P波或R波，发生竞争心律。一般设定值：心房0.51.0mV心室1.52.5mV起搏器常见并发症起搏阈值增高电极移位脱落出血感染AVIPVARP起搏不良感知不良起搏器以什么模式工作？起搏器三项参数如何？起搏器是否缺电？起搏器导线连接是否正常？起搏心电图有无异常？Thank you for your attention!
