心脏复律

心律转复
心律转复
	心律转复示意图;
ICD-9-CM	99.6
MeSH	D004554

心脏复律^[1]（cardioversion）又称心律转复^[2]、心律调整、心搏复原^[3]，是通过电击或药物将异常心律（心跳过速或其他心律失常）转化为正常心律的医学手段。

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心脏电复律（cardiac electroversion）或电击心律转复、心脏电击转复、电复律，是使用电击的方式使心脏复律。药物心律转复或化学心律转复、药物复律，则使用抗心律失常药物，而不是电击^[4]。

电击心律转复

同步电击心律转复（synchronized electrical cardioversion）或同步电复律，是在心脏律动中的一个特定的时间使用特定剂量的电流电击，以矫正活动异常的心脏电传导系统的手段。除颤则使用特定剂量的电流在任意的时刻在电击心脏，这是抢救由心室纤颤和无脉搏室性心动过速（pulseless V-tach）造成的心脏停跳患者的最有效的方法^[5]。

当实施同步电复律时，急救人员使用电极贴片或者传统的手握式电击板，其上附有由盐溶液构成的导电凝胶。理想情况下，应当使得一个电极接触患者前胸，另一个接触患者后背，将心脏像夹心饼干一样夹在中间效果最好。如果没有这个条件，可以如图所示，一个电极接触患者右胸上方，另一个电极接触患者左腹外侧。使用一根电线将电极连接到心律转复仪器上。这是一种既能读取心律又能实施电击的医学仪器。该仪器会读取患者的心律，并找出心动周期。操作人员设置能量后，由仪器执行电击。贴片仪器会在电击指令发出后自动读取心律和电击；电击板式仪器需要医师用力（25磅/120牛顿，相当于12公斤）按在患者皮肤上，按住电击按钮不放，仪器不会立刻电击，医师需要等待仪器分析心律一段时间，然后机器才会电击。

电击心律转复时的安全措施和V-fib电击时相同，包括所有医护人员不能直接触碰患者，同时确保周围没有暴露的氧气流。

建议的能量

心房纤颤：双相仪设为120至200焦耳，单相仪设为200焦耳。（双相仪更加常见，单相仪被很多地方淘汰了）
心房扑动：双相仪设为50至100焦耳，单相仪设为100焦耳。
室性心动过速（有脉搏 V-tach）：双相仪设为100焦耳，单相仪设为200焦耳。
心室纤颤或无脉室性心动过速（V-fib / 无脉搏V-tach）：双相仪设为120-200焦耳，单相仪设为360焦耳，不需同步。^[6]^[7]^[8]

建议的能量和临床情况也有关系。如果是急救和ACLS，则直接开到最大值。如果是医院内的可控情况，则由医生根据具体情况决定。

参见

植入心脏除颤器 (ICD)
经皮起搏

参考文献

[1]
心脏复律. 术语在线. 全国科学技术名词审定委员会. （简体中文）
[2]
心律转复. 术语在线. 全国科学技术名词审定委员会. （简体中文）
[3]
心搏復原. 乐词网. 国家教育研究院. （繁体中文）
[4]
Shea, Julie B.; William H. Maisel. Cardioversion. Circulation. 2002, 106 (22): e176–8. PMID 12451016. doi:10.1161/01.CIR.0000040586.24302.B9. （原始内容存档于2010-01-15）.
[5]
Marino, Paul L. Marino's the ICU book Fourth edition. 2014. ISBN 1451121180.
[6]
Fuster, V; Rydén, LE; Cannom, DS; Crijns, HJ; Curtis, AB; Ellenbogen, KA; Halperin, JL; Le Heuzey, JY; Kay, GN; Lowe, JE; Olsson, SB; Prystowsky, EN; Tamargo, JL; Wann, S; Smith SC, Jr; Jacobs, AK; Adams, CD; Anderson, JL; Antman, EM; Halperin, JL; Hunt, SA; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Priori, SG; Blanc, JJ; Budaj, A; Camm, AJ; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task Force on Practice, Guidelines; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Aug 15, 2006, 114 (7): e257–354. PMID 16908781. doi:10.1161/circulationaha.106.177292.
[7]
Zipes, DP; Camm, AJ; Borggrefe, M; Buxton, AE; Chaitman, B; Fromer, M; Gregoratos, G; Klein, G; Moss, AJ; Myerburg, RJ; Priori, SG; Quinones, MA; Roden, DM; Silka, MJ; Tracy, C; Smith SC, Jr; Jacobs, AK; Adams, CD; Antman, EM; Anderson, JL; Hunt, SA; Halperin, JL; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Blanc, JJ; Budaj, A; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task, Force; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Sep 5, 2006, 114 (10): e385–484. PMID 16935995. doi:10.1161/CIRCULATIONAHA.106.178233.
[8]
Link, MS; Atkins, DL; Passman, RS; Halperin, HR; Samson, RA; White, RD; Cudnik, MT; Berg, MD; Kudenchuk, PJ; Kerber, RE. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.. Circulation. Nov 2, 2010, 122 (18 Suppl 3): S706–19. PMID 20956222. doi:10.1161/CIRCULATIONAHA.110.970954.

外部链接

[1] [1]
心脏复律. 术语在线. 全国科学技术名词审定委员会. （简体中文）

[2] [2]
心律转复. 术语在线. 全国科学技术名词审定委员会. （简体中文）

[3] [3]
心搏復原. 乐词网. 国家教育研究院. （繁体中文）

[Shea2002-4] [4]
Shea, Julie B.; William H. Maisel. Cardioversion. Circulation. 2002, 106 (22): e176–8. PMID 12451016. doi:10.1161/01.CIR.0000040586.24302.B9. （原始内容存档于2010-01-15）.

[5] [5]
Marino, Paul L. Marino's the ICU book Fourth edition. 2014. ISBN 1451121180.

[6] [6]
Fuster, V; Rydén, LE; Cannom, DS; Crijns, HJ; Curtis, AB; Ellenbogen, KA; Halperin, JL; Le Heuzey, JY; Kay, GN; Lowe, JE; Olsson, SB; Prystowsky, EN; Tamargo, JL; Wann, S; Smith SC, Jr; Jacobs, AK; Adams, CD; Anderson, JL; Antman, EM; Halperin, JL; Hunt, SA; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Priori, SG; Blanc, JJ; Budaj, A; Camm, AJ; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task Force on Practice, Guidelines; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Aug 15, 2006, 114 (7): e257–354. PMID 16908781. doi:10.1161/circulationaha.106.177292.

[7] [7]
Zipes, DP; Camm, AJ; Borggrefe, M; Buxton, AE; Chaitman, B; Fromer, M; Gregoratos, G; Klein, G; Moss, AJ; Myerburg, RJ; Priori, SG; Quinones, MA; Roden, DM; Silka, MJ; Tracy, C; Smith SC, Jr; Jacobs, AK; Adams, CD; Antman, EM; Anderson, JL; Hunt, SA; Halperin, JL; Nishimura, R; Ornato, JP; Page, RL; Riegel, B; Blanc, JJ; Budaj, A; Dean, V; Deckers, JW; Despres, C; Dickstein, K; Lekakis, J; McGregor, K; Metra, M; Morais, J; Osterspey, A; Tamargo, JL; Zamorano, JL; American College of Cardiology/American Heart Association Task, Force; European Society of Cardiology Committee for Practice, Guidelines; European Heart Rhythm, Association; Heart Rhythm, Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Circulation. Sep 5, 2006, 114 (10): e385–484. PMID 16935995. doi:10.1161/CIRCULATIONAHA.106.178233.

[8] [8]
Link, MS; Atkins, DL; Passman, RS; Halperin, HR; Samson, RA; White, RD; Cudnik, MT; Berg, MD; Kudenchuk, PJ; Kerber, RE. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.. Circulation. Nov 2, 2010, 122 (18 Suppl 3): S706–19. PMID 20956222. doi:10.1161/CIRCULATIONAHA.110.970954.

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