猝死以及心肺复苏.ppt

* * * * * * * * * Ventricular Fibrillation (VF) is an abnormal, disorganized heart rhythm in which multiple areas in the ventricles are all firing electrical impulses at once. VF has been described as “myocardial chaos”. A heart in VF looks “like a bag filled with live worms.” Ventricular tachycardia (VT) is an abnormal, organized rhythm in which the ventricles are firing very fast – over 150 beats per minute. Both VF and VT produce no effective blood flow, but can be treated by defibrillation. In common terminology, both are considered to be “shockable rhythms.” * Pulseless electrical activity (PEA) is an abnormal, organized electrical rhythm without a corresponding pulse or blood flow. Asystole, commonly known as “flatline,” is an abnormal situation in which there is very little or no cardiac activity and no pulse. It is viewed as a fatal condition, with a survival rate of only 1%. Neither PEA nor asystole can be treated with defibrillation. * Recent studies have shown that VF and VT are the presenting rhythms in significantly less than half the cases of sudden cardiac arrest. Peberdy and Kaye reported that these shockable rhythms occurred in only 27% of hospital cases and Cobb found the incidence to be only 41% in the emergency medical service setting. * * * * * 非急需“电除颤” 的心律失常 无脉性电活动（PEA） 心脏停止（Asystole） 本文档共53页；当前第30页；编辑于星期三\6点9分 * 心脏骤停类型--院内外比较 Peberdy MA, Kaye W, et al. Resuscitation 2003; 58: 297-308. Kaye, W, et al. Journal of the American College of Cardiology. 2002: 39(5), Suppl A. Cobb, L, et al. JAMA. 2002; 288(23): 3008-3013. 25% 41% 75% 59% 0% 20% 40% 60% 80% 100% 120% 院内 院外 VF/VT PEA/Asystole 各种心脏骤停比例 本文档共53页；当前第31页；编辑于星期三\6点9分 * 除颤时间的重要性 VF发作＜5min 除颤容易 VF发作5min 除颤困难 本文档共53页；当前第32页；编辑于星期三\6点9分 * 早期除颤增加存活率 100 100 80 80 60 60 40 40 20 20 0 0 除颤时间（min） 0 0 5 10 15 20 每延缓除颤1min存活率降低10% ICCM， WT， 11/2000 存活率（%） 本文档共53页；当前第33页；编辑于星期三\6点9分 单向波与双向波除颤2015美国CPR指南 低能双向波除颤，先低能量120J，再150J