围手术期间心脏植入装置的管理 专家共识.ppt

围手术期间心脏植入装置的管理 专家共识解读 南昌大学第二附属医院 鲍慧慧 Committee Staff 8AHA/ACC/4ASA/1STS Nashville, TN； Seattle, WA；Houston； TX, Rochester, MN Baltimore； Cleveland, OH Greenville, NC；Hanover, NH Charleston, SC；West Des Moines, IA Cleveland, OH；Jacksonville, FL Charlottesville, VA；Nashville, TN 概 要 介 绍 医疗操作期间可能出现的问题 Problems that can occur during medical procedures Preoperative evaluation of a patient with a 心脏植入性电子装置（ CIED）患者术前评估 心脏植入性电子装置（ CIED）患者手术中管理与思考 Intraoperative management and considerations 心脏植入性电子装置术中的评估Intraoperative evaluation of CIEDs Abbreviations CIED：Cardiovascular implantable electronic devices EMI ： Electromagnetic interference ECT ： Electroconvulsive therapy CIED team： Physician, nurse, and technicians Perioperative team：Anesthesiologist , surgeon，physician, nurse More than 3,000,000 devices were implanted in the globe 全球约有三百万以上患者心脏植入装置 700,000 devices was implanted in 2009 2009年有700,000患者心脏植入装置 Increasing at the rate of 15% every year 每年以15% 速度递增 Ensure patients with devices safe in perioperative period Need for a consistent statement 1、Rapid changes in CIED technology 2、Expanding use of EMI 3、 Confusing recommendations Problems that can occur during medical procedures EMI and CIEDs Electrosurgical energy EMI and CIEDs Transient effection such as ： Pacing inhibition Inappropriate tracking of electrical noise Damage at the lead-tissue interface Pulse generator damage Electrical reset mode Rate responsive algorithms EMI and CIEDs Extent of abnormal behavior depends on ： Strength Duration Particular type of interference Clinical impact depends on ： Patient’s intrinsic rate and rhythm Pacing mode Functioning of protective circuitry engineered to filter out extraneous electrical currents Electrosurgical energy Bipolar electrosurgery ：(e.g. electrical forceps） Used far less commonly only for coagulation and not dissection Monopolar electrosurg