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五、Singlechamberpacing单腔起搏
Apacemakerwithapacingleadpacesineithertherightatrium,ortherightventricle.Theyarerespectivelycalledanatrialsinglechamberpacemaker(AOO,AAI,AAT)orventriclesinglechamberpacemaker(VOO,VVI,VVT),whichareasynchronouspacing.ThesingleatrialpacingisusuallyselectedforthepatientwithanintrinsicAVconductionnormallyexists.
根据起搏的是右心房还是右心室,分别将之称为心房单腔起搏器(AOO,AAI,AAT)或心室单腔起搏器(VOO,VVI,VVT),均为非同步起搏。心房单腔起搏通常用于房室传导功能正常的病人。
六、Dualchamberpacing双腔起搏
Adualchamberpacemaker,whichissynchronouspacing,hasaleadintherightatriumandaleadintherightventriclewiththeconnectionofeachleadtothegenerator.Thedualchamberpacingallowsmaintainingtherelationshipphysiologicallybetweenatrialandventricularcontraction.
双腔起搏器是同步起搏,一根导线置于右心房,一根置于右心室,每一根的另一端连接发生器。双腔起搏允许心房与心室之间维持生理收缩功能。
七、Biventricularpacing双心室起搏
Biventricularpacingdevicehasthreeleads,oneintheatrium,oneintherightventricle,andthethirdisinsertedthroughthecoronarysinustopaceposterolateralwalloftheleftventricle.Itisusedtoimprovecertainpatientwiththeheartfailurebyresynchronizethebothventriclesthatdoesnotbeatinsynchrony.
双心室起搏装置有三根导线,一根置于右心房,一根置于右心室,第三根经冠状窦置于左心室的后侧壁。它通过左右心室之间的再同步化来改善心衰患者的心功能。
八、Implantablecardioverter-defibrillator植入式心脏复律除颤器(ICD)
ICDisdevelopedtodetectacardiactachyarrhythmiaandterminatethembydeliveringahighenergydefibrillatingshocktotheheart.Thepulsegeneratorissomewhatlargerthanthatofapacemaker.Moderndefibrillatorsincludenearlyasmanypacingfeaturesasmodernpacemakers.Adualchamberdefibrillatorhasapacingleadintherightatriumandapacing/defibrillationleadintherightventricle.Thelatterdeliversthedefibrillationshock,aswellaspacing.
ICD用来监测快速性心律失常,并通过向心脏发出高能的除颤电击来终止心律失常。脉冲发生器比起搏器大一些。现代除颤器包括几乎与现代起搏器一样多的起搏功能。双腔除颤器一根起搏导线置于右心房,另一根起搏/除颤导线置于右心室。后者可以释放起搏脉冲也可以进行除颤。
Chapter3Indicationsforcardiacpacing
第三章起搏指征
一、Indicationsfortemporarytransvenouscardiacpacing临时起搏指征
(一)Emergencyforacutemyocardialinfarctionoranyothermyocardialdamagewith:
、Asystole.
2、Third-degreeortypeⅡsecond-degreeAVblock.
3、SymptomaticbradycardiaortypeIsecond-degreeAVblockwithhypotensionnotresponsivetoatropine.
4、Bilateralbundlebranchblock(alternatingBBBorRBBBwithalternatingLAFB/LPFB)
5、Bifascicularblockwithfirst-degreeAVblock.
(一)诸如急性心肌梗死或其他心肌损害等危重情况:
、心脏停搏;
2、三度或二度II型房室传导阻滞;
3、有症状的心动过缓或低血压、且阿托品无反应的二度I型房室传导阻滞;
4、双束支阻滞(交替性左、右束支阻滞伴左前或左后分支阻滞);
5、伴有一度房室传导阻滞的双分支阻滞。
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