文档介绍：围手术期间心脏植入装置的管理
专家共识解读
南昌大学第二附属医院鲍慧慧
The Heart Rhythm Society Expert Consensus
(2011 AHA/ACC/ASA/STS)
Committee Staff 8AHA/ACC/4ASA/1STS
Nashville, TN; Seattle, WA;Houston;
TX, Rochester, MN Baltimore; Cleveland, OH Greenville, NC;Hanover, NH
Charleston, SC;West Des Moines, IA
Cleveland, OH;Jacksonville, FL
Charlottesville, VA;Nashville, TN
Engineers from:
概要
介绍
医疗操作期间可能出现的问题 Problems that can occur during medical procedures
Preoperative evaluation of a patient with a
心脏植入性电子装置( CIED)患者术前评估
心脏植入性电子装置( CIED)患者手术中管理与思考 Intraoperative management and considerations
心脏植入性电子装置术中的评估Intraoperative evaluation of CIEDs
Abbreviations
CIED:Cardiovascular implantable electronic devices
EMI : ic interference
ECT : Electroconvulsive therapy
CIED team: Physician, nurse, and technicians
Perioperative team:Anesthesiologist , surgeon,physician, nurse
More than 3,000,000 devices were implanted in the globe
全球约有三百万以上患者心脏植入装置
700,000 devices was implanted in 2009
2009年有700,000患者心脏植入装置
Increasing at the rate of 15% every year
每年以15% 速度递增
Introduction
Ensure patients with devices safe in perioperative period
Need for a consistent statement
1、Rapid changes in CIED technology
2、Expanding use of EMI
3、 Confusing mendations
Introduction
Problems that can occur during medical procedures
EMI
Electrosurgical energy
EMI and CIEDs
Electrosurgical energy
Identification of problems specific to patients with CIED during medical procedures
Oversensing
Rate responsive algorithms
Reset
Pulse generator damage
Lead-tissue interface damage
EMI and CIEDs
Transient effection such as :
Pacing inhibition
Inappropriate tracking of electrical noise
Damage at the lead-tissue interface
Pulse generator damage
Electrical reset mode
Rate responsive algorithms
Extent of abnormal behavior depends on :
Strength
Duration
Particular type of interference
Clinical impact depends on :
Patient’s intrinsic rate and rhythm
Pacing mode
Functioning of protective circuitry engineered to filter