ACLS幻灯高级心脏生命支持课件

1

ACLSUpdate-2006南京中医药大学附属医院麻醉科崔苏扬教授ACLSin2006ACLS高级心脏生命支持更新基本心律失常复习提高我们的认识MajorChanges-2006强调灌注重要性(减少按压被打断次数)按压及呼吸次数的改变(30:2)再次肯定了AEDs的重要性不推荐盲目提高肾上腺素使用剂量强调发生心血管意外时，某些快速起效药物的应用.Defibrillation除颤AllhealthcareprovidersshouldbetrainedindefibrillationRecommendationforearlydefibrillationforhospitalsandoutpatientareas(IIa)Defibrillation除颤WaveformMonophasic单相Biphasic双相室颤或者无脉室速-2001ACLS无脉处理原则.Asystole心搏暂停PulselessElectricalActivity无脉电活动心搏暂停及无脉电活动处理原则VentricularTachycardia?

室性心动过速ACLS心动过速处理原则AVBlocksAV传导阻滞Bradycardia心动过缓Ⅱ度AVBlock,MobitzIⅡ度AVBlock,MobitzIIⅡ度AVBlock,2:1Ⅲ度AVBlock心动过缓处理原则.ACLS药物治疗Vasopressin抗利尿激素PositiveepieffectswithoutepisideeffectsLongerlasting(10to20min)1dose:wait10minbeforemoreepiorvasoAmiodarone胺碘酮ConsiderforVF/pulselessVTEvidenceformeaningfulsurvivallackingHandicappedbyextremedifficultyingivingforemergenciesExcellentforalltachycardias,especiallyifsickheartBretylium溴苄胺:

nolongerrecommendedLidocaine利多卡因:

anoldfriendbackedbypoorevidence心源性猝死的发生率心源性猝死的发生率--SCDSCDisthemostcommoncauseofdeathintheU.S.Incidence:300,000to400,000eachyear(U.S.)Only2%–15%reachthehospitalHalfoftheseearlysurvivorsdiebeforedischargeAtrium心房&Ventricle心室Bradycardiasensing心动过缓传感Bradycardiapacing心动过缓起搏Bi-ventricularpacing双相起搏Ventricle心室预防VTAntitachycardiapacing抗心动过速起搏Cardioversion心脏复律Defibrillation除颤心源性猝死的双相起搏

心源性猝死治疗进展:1980toPresentNumberofWorldwideICDImplantsPerYear1980FirstHuman

Implant1985FDAApproval

ofICDs1989Transvenous

LeadsBiphasic

Waveform1993Smaller

Devices1996Steroid

LeadsMADIT010,00020,00030,00040,00050,00060,00070,00080,00090,000100,00019801985199019952000E1999MUSTTATTherapies1997/98DCICDsSize

ReductionAVIDCASHCIDS1988Tiered

TherapyLargedevices–经腹部Firsthumanimplants埋植Thoracotomy胸廓切开术,multipleincisions多个切口Generalanesthesia全身麻醉Longhospitalstays住院期长Complicationsfrommajorsurgery并发症多Perioperativemortalityupto死亡率9%Nonprogrammabletherapy非编程Devicelongevity使用寿命为1.5years＜1,000implants埋植/year1980Smalldevices–经胸部First-linetherapyforVT/VFpatientsTransvenous经静脉,singleincision小切口Localanesthesia局部麻醉;conscioussedation清醒的Shorthospitalstays住院期短Fewcomplications并发症少Perioperativemortality<1%Programmabletherapyoptions程序控制的Batterylongevityupto使用寿命为9years＞55,000implants/year今天ACLS更新Themajordifferencebetweenmonophasicandbiphasicwaveformdefibrillationis:

单相双相波除颤主要区别:

A.ThesizeofthedefibrillatorB.AsingleversustwophaseshockC.PacingcapabilityD.Oxygenmonitoring

Answers:

B2.Vasopressinisindicatedforthetreatmentofasystole抗利尿激素可以用于心搏暂停吗?A.TrueB.FalseAnswer:A

3.InterventionsproventoimprovethesuccessofresuscitationinVFcardiacarrestinclude

心室颤动复苏的步骤:

A.CPR,defibrillation除颤,amiodarone胺碘酮B.CPR,defibrillation除颤,lidocaine利多卡因C.CPR,defibrillation除颤,epinephrine肾上腺素D.Alltheabove

Answers:A4,treatmentofVF/PauselessVT,IVamiodaroneisgivenas:

胺碘酮用于室颤或者无脉室速剂量？A.150mgover10minutesB.300mgIVpushC.1mg/mininfusionD.1gmIVpushAnswer:B5.DuringcardiacarrestduetoVF,vasopressinisgivenas:

抗利尿激素用于心搏停止的剂量？A.1mgrepeatedevery5minutesB.1U/mininfusionC.40UnitssingleIVdoseD.VasopressinisnotindicatedinVFcardiacarrestAnswer:C6.SideeffectsassociatedwithrapidadministrationofIVamiodaroneinclude

胺碘酮副作用:

A.Rash疹B.Tachycardia心动过速C.TorsadedepointesD.Hypotension低血压andbradycardia心动过缓Answer:D7.Limitingfeaturesofusingprocainamideincardiacarrestare:普鲁卡因胺用于心搏停止的局限性？A.TheneedforgivingthedrugasaslowinfusiononlyduringaperfusingrhythmB.InabilitytogivethedrugasaboluswithoutserioustoxicityC.PotentialadverseeffectsinpatientswithpoorheartfunctionD.AlloftheaboveAnswer:

DThemostcommonarrhythmiaresponsibleforsuddencardiac

arrestis:

引起心搏骤停最常见的心律失常：A.VF室颤B.PEA无脉心跳骤停C.VT室速D.Asystole心搏暂停

Answer:A9.Anewpotentialtreatmentforcardiacarrest:

用于心搏停止一个新的有希望的治疗方案:A.Hyperbaricoxygen高压氧B.Hypothermia低温C.BNP(B-typenatriureticpeptide促尿钠排泄肽)D.Steroids类固醇An