不同导电介质用于急诊PCI并发心室颤动电除颤疗效分析
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摘要
目的探讨两种导电介质在急诊经皮冠状动脉介入治疗(PCI)并发心室颤动(室颤)患者中电除颤的安全性和有效性,从而提高电除颤的整体疗效。方法选取2010年1月~2016年12月于北京协和医院心脏导管室救治的急性心肌梗死行急诊PCI术中发生室颤的患者80例,随机分为对照组和观察组,每组各40例,对照组采用浆形电极板上涂导电糊为导电介质的方法进行电除颤,观察组用生理盐水浸泡纱布直接置于除颤部位进行电除颤,比较两组患者电除颤抢救的整体疗效。结果两组患者一次电除颤成功率比较,观察组与对照组相比无明显差异(60%vs.50%,P>0.05)。观察组电除颤平均用时较对照组显著缩短(0.80±0.49 min vs.1.86±0.79 min),且差异具有统计学意义(P<0.05)。观察组皮肤灼伤发生率显著低于对照组(5%vs.35%,P<0.05),皮肤灼伤范围观察组低于对照组(中心局部印记5.0%vs.22.5%,P<0.05)。结论对急诊PCI并发室颤患者,应用生理盐水纱布为电除颤导电介质,可显著缩短除颤时间、减少皮肤灼伤,电除颤成功率相似,显示出较好的安全性和有效性,利于室颤的抢救。
Objective To evaluate the efficacy and safety of two kinds of defibrillation electric conduction medium for patients with ventricular fibrillation during primary percutaneous coronary intervention. Methods 80 patients diagnosed as acute myocardial infarction with ventricular fibrillation during primary PCI from Jan 2010 to Dec 2016,were randomly divided into two groups(40 patients in each group): control group received electrical defibrillation using ultrasound couplant as conducting medium, and experimental group received electrical defibrillation using gauzes soaked in normal saline as conducting medium. The outcomes were success rate of first defibrillation, the average time of defibrillation, the incidence and severity of cutaneous burns. Results The success rate of first defibrillation had no statistical significance between 2 groups(60% vs. 50%,P>0.05). The average time of defibrillation was shortened significantly in experimental group(0.80±0.49 min vs. 1.86±0.79 min, P<0.05).The incidence and severity of cutaneous burns was lower significantly in experimental group(5% vs. 35%,P<0.05). Conclusion Compared with traditional ultrasound couplant, using gauzes soaked in normal saline as conducting medium showed better efficacy and safety, which seemed more suitable for patients with ventricular fibrillation during primary PCI.
Objective To evaluate the efficacy and safety of two kinds of defibrillation electric conduction medium for patients with ventricular fibrillation during primary percutaneous coronary intervention. Methods 80 patients diagnosed as acute myocardial infarction with ventricular fibrillation during primary PCI from Jan 2010 to Dec 2016,were randomly divided into two groups(40 patients in each group): control group received electrical defibrillation using ultrasound couplant as conducting medium, and experimental group received electrical defibrillation using gauzes soaked in normal saline as conducting medium. The outcomes were success rate of first defibrillation, the average time of defibrillation, the incidence and severity of cutaneous burns. Results The success rate of first defibrillation had no statistical significance between 2 groups(60% vs. 50%,P>0.05). The average time of defibrillation was shortened significantly in experimental group(0.80±0.49 min vs. 1.86±0.79 min, P<0.05).The incidence and severity of cutaneous burns was lower significantly in experimental group(5% vs. 35%,P<0.05). Conclusion Compared with traditional ultrasound couplant, using gauzes soaked in normal saline as conducting medium showed better efficacy and safety, which seemed more suitable for patients with ventricular fibrillation during primary PCI.
引文
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[12]李甘杨,韩福生,孙涛,等.ST段抬高心肌梗死急诊冠脉介入中室颤发生的分析[J].赣南医学院学报,2008,28(3):347-9.
[13]叶里努·色尔哈孜.早期电除颤用于心搏骤停患者抢救分析[J].内蒙古中医药,2013,32(12):38.
[14]曹志宇.早期电除颤在心肺复苏中的重要意义[J].中国实用医药,2012,07(11):66-7.
[15]蔡淑昕.三种导电剂在心电图检查中的应用[J].中国保健营养,2016,26(27):153-4.
[16]邓吉华.两种导电介质除颤效果的比较[J].江西医学院学报,2003,43(5):20.
[17]牟小军,卢瑞华,麦纪严.2种除颤导电介质效果比较[J].中国实用护理杂志,2000,16(2):22.
[2]Henriques JP,Gheeraert PJ,Ottervanger JP,et al.Ventricular fibrillation in acute myocardial infarction before and during primary PCI[J].Int J Cardiol,2005,105(3):262-6.
[3]李静,黄萍.心肌梗死患者院内转运途中频发室颤的抢救[J].中华护理杂志,2015,50(4):508-9.
[4]Zijlstra JA,Stieglis R,Riedijk F,et al.Local lay rescuers with AEDs,alerted by text messages,contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system[J].Resuscitation,2014,85(11):1444-9.
[5]李银福,刘建林,王莉敏.室颤一分钟内除颤的疗效分析[J].临床麻醉学杂志,2006,22(4):314.
[6]王冬香.急性心肌梗死合并多次室颤电除颤抢救成功2例报告[J].山西医科大学学报,2011,42(12):1007-8.
[7]Spearpoint KG,Mclean CP,Zideman DA.Early defibrillation and the chain of survival in'in-hospital'adult cardiac arrest;minutes count[J].Resuscitation,2000,44(3):165-9.
[8]Demidova MM,Smith JG,Hoijer CJ,et al.Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI[J].Eur Heart J Acute Cardiovasc Care,2012,1(4):302-11.
[9]Ambler JJ,Sado DM,Zideman DA,et al.The incidence and severity of cutaneous burns following external DC cardioversion[J].Resuscitation,2004,61(3):281-8.
[10]Taylor J.Third universal definition of myocardial infarction[J].Eur Heart J,2012,33(20):2506-7.
[11]周玉英,吴琴华,钱锡芬.传统电休克治疗精神病致电灼伤15例报告[J].中国民康医学,2006,18(2):44.
[12]李甘杨,韩福生,孙涛,等.ST段抬高心肌梗死急诊冠脉介入中室颤发生的分析[J].赣南医学院学报,2008,28(3):347-9.
[13]叶里努·色尔哈孜.早期电除颤用于心搏骤停患者抢救分析[J].内蒙古中医药,2013,32(12):38.
[14]曹志宇.早期电除颤在心肺复苏中的重要意义[J].中国实用医药,2012,07(11):66-7.
[15]蔡淑昕.三种导电剂在心电图检查中的应用[J].中国保健营养,2016,26(27):153-4.
[16]邓吉华.两种导电介质除颤效果的比较[J].江西医学院学报,2003,43(5):20.
[17]牟小军,卢瑞华,麦纪严.2种除颤导电介质效果比较[J].中国实用护理杂志,2000,16(2):22.