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,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。,起搏器的组成,脉搏发生器,及电源,导线,电极,脉冲发生器,脉冲发生器,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,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,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 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),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,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,现用起搏器,Medtronic 5348,单腔临时起搏器,Osykpa,PACE 101H,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,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,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,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,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,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,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,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,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,起搏器常见并发症,起搏阈值增高,电极移位脱落,出血,感染,A V I,P V A R P,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!,