心外_临时起搏器课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式abc123,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式abc123,第二级,第三级,第四级,第五级,*,临时起搏器的应用与观察,临时起搏器的应用与观察,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。,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,起搏器的组成,脉搏发生器,及电源,导线,电极,起搏器的组成脉搏发生器导线电极,脉冲发生器,脉冲发生器,脉冲发生器,脉冲发生器,心外_临时起搏器课件,电极的固定方法,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,电极的固定方法主动固定被动固定被动固定,起搏器命名代码,NASPE,：,N,orth,A,merican,S,ociety of,P,acing and,E,lectrophysiology,BPEG,：,B,ritish,P,acing and,E,lectrophysiology,G,roup,N,ASPE/,B,PEG,G,eneric(NBG),Pacemaker Code,起搏器命名代码NASPE：North American So,The 1987 NASPE/BPEG Generic(NBG)Pacemaker Code,Position,I,II,III,IV,V,Category:,Chamber(s)paced,Chamber(s)sensed,Response(s)to sensing,Program-mability,rate modulation,Antitachy-arrhythmia function(s),O,=None,A,=Atrium,V,=Ventricle,D,=Dual(A+V),O,=None,A,=Atrium,V,=Ventricle,D,=Dual(A+V),O,=None,T,=Triggered,I,=Inhibited,D,=Dual(T+I),O,=None,P,=Simpleprogram-mable,M,=Multi-program-mable,C,=Communi-cating,R,=Rate modulation,O,=None,P,=Pacing(anti-tachyarrhyth-mia),S,=Shock,D,=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 1987 NASPE/BPEG Generic(N,The NASPE/BPEG Generic(NBG)Pacemaker Code,(Revised 2000),Position,I,II,III,IV,V,Category:,Chamber(s)paced,Chamber(s)sensed,Response to sensing,Rate modulation,Multisite pacing,O,=None,A,=Atrium,V,=Ventricle,D,=Dual(A+V),O,=None,A,=Atrium,V,=Ventricle,D,=Dual(A+V),O,=None,T,=Triggered,I,=Inhibited,D,=Dual(T+I),O,=None,R,=Rate modulation,O,=None,A,=Atrium,V,=Ventricle,D,=Dual(A+V),Mfrdesignation only:,S,=Single(A or V),S,=Single(A or V),The NASPE/BPEG Generic(NBG)P,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,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（临时起搏器）起搏时间在4周以内,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,起搏治疗适应征（永久起搏器）伴有症状的病态窦房结综合征,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,起搏器植入方法经静脉心内膜起搏,现用起搏器,Medtronic 5348,单腔临时起搏器,Osykpa,PACE 101H,现用起搏器Medtronic 5348 单腔临时起搏器Osy,Medtronic 5348,安全特性,系统自检,低电量提示（,24h,）,替换电池时可连续操作,80ppm 10mA 15,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,Medtronic 5348 安全特性系统自检,Medtronic 5348,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,360w,s,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,Medtronic 5348 安全特性快速心房起搏处的提醒标,Medtronic 5348,性能参数,Modes,：,VVI,，,VOO,，,AAI,，,AOO,Basic Pacing Rates,：,30,180 ppm continuously adjustable,Rapid Atrial Pacing Rates,：,80,380 ppm,（,5 ppm increments,）,380,540 ppm,（,10 ppm increments,）,540,800 ppm,（,20 ppm increments,）,Output Amplitude,：,0.1,20 mAcontinuously adjustable,Pulse Width,：,1.8 ms,Medtronic 5348 性能参数Modes：VVI，,Medtronic 5348,性能参数,Sensitivity,：,0.5,20 mVcontinuously adjustable,，,ASYNC,Refractory,：,250 ms,Dimensions,：,18.8 x 6.1 x 4.1 cm(7.4 x 2.4 x 1.6 inches)283 gm(10 oz.)with battery,Battery Type,：,Standard 9V,，,Alkaline or Lithium,Battery Life at nominal settings and typical conditions,：,Alkaline,：,300 hoursLithium,：,650 hours,Medtronic 5348 性能参数Sensitivity,心外_临时起搏器课件,现用起搏器,Medtronic 5388,双腔临时起搏器,现用起搏器Medtronic 5388 双腔临时起搏器,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,Ventricular:0.1-25 mA,Pulse Width Atrial:1.0 msVentricular:1.5 ms,Medtronic 5388 性能参数Modes:DDD,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 21.1 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,Medtronic 5388 性能参数Sensitivity,起搏器参数调节,成人：,90100ppm,婴幼儿：,120,140ppm,起搏频率设定,儿童：,100,120ppm,起搏器参数调节成人：90100ppm婴幼儿：120140,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,0.7,1.0mA,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,3,5mA,或,1.5,3V,，设定电压,3,6V,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,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,0.5,1.0mV,心室,1.5,2.5mV,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，,起搏器常见并发症,起搏阈值增高,电极移位脱落,出血,感染,起搏器常见并发症起搏阈值增高,心外_临时起搏器课件,A V I,A V I,P V A R P,P V A R P,心外_临时起搏器课件,起搏不良,感知不良,起搏不良感知不良,心外_临时起搏器课件,心外_临时起搏器课件,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？,起搏器以什么模式工作？,Thank you for your attention!,Thank you for your attention!,