体外同步直流电复律的急诊应用与分析

目的:评价体外同步直流电复律治疗异位性快速性心律失常(心室颤动除外)的效果及安全性。方法:对2007年7月~2011年6月接受体外同步直流电复律治疗的21例患者的临床资料进行回顾性分析,所有患者均伴有血流动力学障碍,其中阵发性室性心动过速(简称室速)8例,室上性心动过速(简称室上速)5例,预激合并心房颤动(简称房颤)4例,单纯房颤4例。所有患者心律失常发生时间小于48 h。使用双向波电复律机,能量分别给予70~100J,选择同步电复律,年龄>60岁或基础病复杂者先床旁临时起搏后再复律。复律后持续心电24h监测,随访30d。结果:19例70 J一次电复律成功,2例室速者70 J后复律未成功,第二次改为100 J复律成功,血流动力学障碍纠正。复律心电24 h监测,并随访30 d,1例房颤者复发,未发生栓塞及死亡事件。结论:体外同步直流电复律疗效迅速而安全,并发症发生率低。对于年龄超过60岁或基础病复杂者,先床旁临时起搏再电复律,可降低电复律致缓慢性心律失常的副作用,提高其安全性。

Emergency Application and Analysis of Vitro Direct Current Synchronised Cardioversion

Objective:To evaluate the result and safety of vitro direct current synchronised cardioversion for ectopic tachyarrhythmia.Methods:Between July 2007 and June,21 patients(mean age 57 years,range 39～82 years) under vitro direct current synchronised cardioversion who have hemodynamics disoder,including 8 of ventricular tachycardia,5 of supraventricular tachycardia,4 of preexcitation combined fibrillation atrial and 4 of fibrillation atrial.The time of occurrence for the arrhythmia is less than 48 hours.Biphasic wave electrovert machine is selected,and power is defferent from 70 to 100 J,than choose "synchrony".Temporary pacemaker is included ahead for the person of cardiac insufficiency.Continuing electrocardio-monitoring is needed for 24 hours after the cardioversion and all the paitients followed up for 30 days.Results:19 paitients is succesful once for 70J,2 paitients of ventricular tachycardia need 100 J second time after the first 70 J and succesful,and all the hemodynamics is rectification.when followed up,1 patient have fibrillation atrial once more,have no embolizion and death occurrence.Conclusion:The effect of vitro direct current synchronised cardioversion is fast and safe,the incedence of complication is low.For the patient whose age is older than 60 years or disease is complecated,Temporary pacemaker before cardioversion can reduce the adverse effect which is bradyarrhythmias,and improve the safety.