作　　者： (朱雪清）; (何芳）; (袁胜）; (车向阳）; (赵艳伟）;

机构地区： 中国医学科学院北京协和医院心脏导管室,北京100730

出　　处： 《中国循证心血管医学杂志》 2017年第8期988-990,共3页

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.Methods80patients diagnosed as acute myocardial infarction with ventricular fibrillation during primary PCI from Jan2010to Dec2016,were randomly divided into two groups(40patients 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 between2groups(60%vs.50%,P>0.05).The average time of defibrillation was shortened significantly in experimental group(0.80±0.49min vs.1.86±0.79min,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.

关 键 词： 急性心肌梗死 经皮冠状动脉介入 心室颤动 电除颤 导电介质