一例高龄危重患者救治体会.ppt

2008年5月后，病情相对稳定，呼吸机，肠内外营养维持治疗，生命体征平稳。 心电监测经常提示有窦性心律出现。 2010年1月腹腔囊肿破裂，腹腔内形成大量胶冻状液体，出现进行性少尿，全身浮肿明显，阴囊肿大，血压靠大量多巴胺维持。 2月后出现全身黄染，并逐渐加重，以直接胆红素升高为主，病情恶化，少尿，CRRT治疗，2010年2月19日死亡。 住院期间，组织全院大会诊29次。 Indications for Permanent Pacing A. Pacing for Acquired Atrioventricular Block in Adults B. Pacing for Chronic Bifascicular and Trifascicular C. Pacing for Atrioventricular Block Associated With Acute Myocardial Infarction D. Pacing in Sinus Node Dysfunction E. Prevention and Termination of Tachyarrhythmias by Pacing G. Pacing in Children, Adolescents, and Patients With Congenital Heart Disease H. Pacing in Specific Conditions Pacing for Acquired Atrioventricular Block in Adults Class I 1 Third-degree and advanced second-degree AV block at any anatomic level, associated with any one of the following conditions: Bradycardia with symptoms (including heart failure) presumed to be due to AV block. Arrhythmias and other medical conditions that require drugs that result in symptomatic bradycardia. Documented periods of asystole greater than or equal to 3.0 seconds or any escape rate less than 40 bpm in awake, symptom-free patients. After catheter ablation of the AV junction. There are no trials to assess outcome without pacing, and pacing is virtually always planned in this situation unless the operative procedure is AV junction modification. Postoperative AV block that is not expected to resolve after cardiac surgery. Neuromuscular diseases with AV block, such as myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb’s dystrophy (limb-girdle), and peroneal muscular atrophy, with or without symptoms, because there may be unpredictable progression of AV conduction disease. 2 Second-degree AV block regardless of type or site of block, with associated symptomatic bradycardia Class III Asymptomatic first-degree AV block. Asymptomatic type I second-degree AV block at the supra-His (AV node) level or not known to be intra- or infra-Hisian. AV block expected to resolve