一、除顫儀能量的選擇什么原則
除(chu)顫(zhan)需要(yao)能(neng)量(liang),除(chu)顫(zhan)時選擇適當(dang)能(neng)量(liang)以產生充(chong)分的經心肌的電(dian)流(liu)。如果(guo)能(neng)量(liang)和(he)電(dian)流(liu)過低,電(dian)擊就不能(neng)終(zhong)止心律(lv)失常(chang)。如果(guo)能(neng)量(liang)和(he)電(dian)流(liu)過高,就會造成功能(neng)和(he)形態學損傷(shang)。在(zai)成人(ren)中體型大小和(he)除(chu)顫(zhan)所需的能(neng)量(liang)之間并無明確的關系,經胸的阻(zu)抗并不起(qi)重(zhong)要(yao)作用。
第(di)一(yi)次除(chu)顫(zhan)的(de)(de)推薦能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)要達(da)到200J,第(di)二次電(dian)(dian)(dian)(dian)擊能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)水平應(ying)(ying)當(dang)(dang)是200~300J。所(suo)給予的(de)(de)任(ren)何能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)均有可能(neng)(neng)(neng)(neng)(neng)(neng)達(da)到除(chu)顫(zhan),因(yin)此可指定一(yi)個(ge)能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)范圍50~360J。由于經胸(xiong)阻抗會隨著反復電(dian)(dian)(dian)(dian)擊而降低,故隨后的(de)(de)電(dian)(dian)(dian)(dian)擊即便能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)相同(tong),所(suo)產生的(de)(de)電(dian)(dian)(dian)(dian)流也會較高。為此,如果(guo)第(di)一(yi)次電(dian)(dian)(dian)(dian)擊不(bu)能(neng)(neng)(neng)(neng)(neng)(neng)終止室顫(zhan),最好在第(di)二次電(dian)(dian)(dian)(dian)擊時重復給予與第(di)一(yi)次一(yi)樣的(de)(de)能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)。如果(guo)頭兩(liang)次電(dian)(dian)(dian)(dian)擊未能(neng)(neng)(neng)(neng)(neng)(neng)除(chu)顫(zhan),應(ying)(ying)當(dang)(dang)立即給360J的(de)(de)第(di)三次電(dian)(dian)(dian)(dian)擊。如果(guo)經電(dian)(dian)(dian)(dian)擊VF雖已終止,但是此后又出現,應(ying)(ying)當(dang)(dang)再進行(xing)電(dian)(dian)(dian)(dian)擊,所(suo)給的(de)(de)能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)應(ying)(ying)當(dang)(dang)是前次除(chu)顫(zhan)成功所(suo)給予的(de)(de)水平。只有在電(dian)(dian)(dian)(dian)擊不(bu)能(neng)(neng)(neng)(neng)(neng)(neng)終止除(chu)顫(zhan)時,才應(ying)(ying)增(zeng)加電(dian)(dian)(dian)(dian)擊能(neng)(neng)(neng)(neng)(neng)(neng)量(liang)(liang)。
電(dian)復律(lv)所用電(dian)能用“J”表示。按需要量充(chong)電(dian),心室顫動(dong)為(wei)250~300J非同(tong)步(bu)(bu)復律(lv)。室性心動(dong)過(guo)速為(wei)150~200J,心房顫動(dong)為(wei)150~200J,心房撲動(dong)為(wei)80~100J,室上性心動(dong)過(guo)速為(wei)100J,均為(wei)同(tong)步(bu)(bu)復律(lv)。
二、使用除顫儀需要哪些術后護理
1、復律后(hou)需要持續進行心電監護至少(shao)24小時,觀察(cha)患者心率、脈(mo)搏、呼吸、血(xue)壓(ya)等生命體(ti)征,2小時內需要禁食。
2、除顫后(hou)患者可以繼續服用胺碘酮等藥物維持竇性心律。
3、檢查靜脈通路和監測管(guan)道是否通暢,以確保急(ji)救用(yong)藥,進行(xing)血流動力學監測。
4、需要密切(qie)觀察(cha)患者(zhe)心率、呼吸、血壓、面色、神志等病況,根(gen)據情(qing)況給予酌情(qing)處理。
5、除顫后需要注意局(ju)部皮膚有無灼傷,加強復(fu)蘇(su)后對腦水腫、心功能不(bu)全等并發(fa)癥進(jin)行護理。