临时起搏器解读

1、临时起搏器解读临时起搏器解读第1页人工心脏起搏是用人工脉冲电流刺激心脏以开启心搏，从而代替心脏本身起搏点，主要用于治疗迟缓性心律失常，也用于抑制快速性心律失常。若心肌已丧失兴奋收缩特征，则起搏无效。临时起搏器解读第2页起搏器组成脉搏发生器及电源导线电极临时起搏器解读第3页脉冲发生器临时起搏器解读第4页脉冲发生器临时起搏器解读第5页临时起搏器解读第6页电极固定方法主动固定螺旋式电极头被动固定齿状电极头被动固定鳍状电极头临时起搏器解读第7页起搏器命名代码NASPE：North American Society of Pacing and ElectrophysiologyBPEG：British

2、Pacing and Electrophysiology GroupNASPE/BPEG Generic (NBG) Pacemaker Code临时起搏器解读第8页The 1987 NASPE/BPEG Generic (NBG) Pacemaker Code PositionIIIIIIIVVCategory:Chamber(s) pacedChamber(s) sensedResponse(s) to sensingProgram- mability, rate modulationAntitachy- arrhythmia function(s)O = NoneA = AtriumV

3、= 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- turersdesign

4、ation only:S = Single(A or V)S = Single(A or V)Note: Positions I through III are used exclusively for antibradyarrhythmia function.临时起搏器解读第9页The NASPE/BPEG Generic (NBG) Pacemaker Code(Revised )PositionIIIIIIIVVCategory:Chamber(s) pacedChamber(s) sensedResponse to sensingRate modulationMultisite pac

5、ingO = 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)临时起搏器解读第10页起搏器分类非同时起搏器同时起搏器P波同时

6、R波同时次序起搏器程控型起搏器单腔起搏器双腔起搏器暂时起搏器（体外携带式）永久起搏器（体内埋藏式）临时起搏器解读第11页起搏治疗适应征（暂时起搏器）起搏时间在4周以内急性心肌炎引发度、度房室传导阻滞并阿斯综合征发作，药品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品中毒，电解质紊乱所致心脏阻滞心脏手术后可能系水肿、炎症所致完全性房室传导阻滞有高度房室传导阻滞或窦房结功效不全患者，外科手术期间保护性应用临时起搏器解读第12页起搏治疗适应征（永久起搏器）伴有症状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，症状显著者手术损伤传导系统引发不可逆性房室传导阻滞药

7、品治疗无效、重复发作快速性心律失常，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临时起搏器解读第13页起搏器植入方法经静脉心内膜起搏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临时起搏器解读第14页现用起搏器Medtronic 5348 单腔暂时起搏器Osykpa PACE 101H临时起搏器解读第15页Medtronic 5348 安全特征系统自检低电量提醒（24h）替换电池时可连续操作80ppm 10mA 15秒可颠倒电池电极受保护控制面板及导线接口安全关机操作临时起搏器解读第16页Medtronic 5348 安全特征快速心房起搏处提醒标志频率和灵敏度拨盘

8、上高亮标识和拨动限制抗击360ws除颤能量静电保护在电磁环境中确保受干扰程度最小安全中继线临时起搏器解读第17页Medtronic 5348 性能参数Modes：VVI， VOO， AAI， AOOBasic Pacing Rates：30180 ppm continuously adjustableRapid Atrial Pacing Rates： 80380 ppm（5 ppm increments）380540 ppm（10 ppm increments）540800 ppm（20 ppm increments）Output Amplitude：0.120 mAcontinuously

9、 adjustablePulse Width：1.8 ms临时起搏器解读第18页Medtronic 5348 性能参数Sensitivity：0.520 mVcontinuously adjustable，ASYNCRefractory：250 msDimensions：18.8 x 6.1 x 4.1 cm(7.4 x 2.4 x 1.6 inches)283 gm (10 oz.) with batteryBattery Type：Standard 9V， Alkaline or LithiumBattery Life at nominal settings and typical con

10、ditions：Alkaline：300 hoursLithium：650 hours临时起搏器解读第19页临时起搏器解读第20页现用起搏器Medtronic 5388 双腔暂时起搏器临时起搏器解读第21页Medtronic 5388 性能参数Modes: DDD, DDI, DVI, DOO, AAI, AOO, VVI, VOO Base Pacing Rate: 30-200 ppm Upper Rate: 80-230 ppm Rapid Atrial Pacing Rate: 80-800 ppm Output Amplitude Atrial: 0.1-20mA Ventricul

11、ar: 0.1-25 mA Pulse Width Atrial: 1.0 msVentricular: 1.5 ms 临时起搏器解读第22页Medtronic 5388 性能参数Sensitivity Atrial: 0.4-10 mV, async. Ventricular: 0.8-20 mV, async. A-V Interval: 20-300 ms Refractory Period Atrial: 150-500 ms Ventricular: 250 ms Ventricular Blanking Pace: 125 ms Sense: 75 ms Dimensions 21

12、.1 x 8.1 x 3.6 cm (8.3 x 3.2 x 1.4 in.)510 g (18 oz.) with battery Battery Type: Standard 9 V, Alkaline or Lithium Battery Life Alkaline: 9 days typical Lithium: 16 days typical临时起搏器解读第23页起搏器参数调整成人：90100ppm婴幼儿：120140ppm起搏频率设定儿童：100120ppm临时起搏器解读第24页起搏器参数调整起搏阈值：每次都能引发心脏起搏最小电压或电流。将电压和电流逐步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电压和电流即为起搏阈值。普通起始阈值：电压0.5V，电流0.71.0mA设定工作输出应为阈值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临时起搏器解读第25页起搏器参数调整感知灵敏度：感知过高会将T波误感为P波或R波，造成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。普通设定值：心房0.51.0mV 心室1.52.5mV临时起搏器解读