除颤能量的合理选择

The logical choice for defibrillation energy

目的探求合适的除颤（DF）能量，以期在不降低DF成功率的前提下，尽量减少DF对患者的损伤，利于心肺复苏（CPR）成功后患者进一步的治疗。方法对我院重症医学科2007-01-2012-01间快速致死性心律失常而紧急DF的93例患者每次DF前都常规记录其波形，除颤仪为双相切角指数波型（BTE）。并留取DF前5s的波形作为研究对象。回顾分析当时所选DF能量、快速致死性心律失常波形与DF成功率的关系。结果①对不稳定性多形性室速、无脉性室速、室扑，应用150J的能量DF，DF成功率极高，几乎可达100％。②室颤（VF）的频率和振幅呈正相关关系，随着VF时间的延长，VF的频率和振幅会同步迅速变小。③当VF波的振幅≤0．2mV或频率≤200次／min时，150J和200JDF成功率均极低，且两组比较差异无统计学意义；当VF波的振幅〉0．6mV或其频率〉4007次／min时，150J或200JDF成功率均高达90％以上，且两组比较差异无统计学意义；当VF波振幅为0．2-0．6mV或其频率为200—400次/Jmin时，150J或200JDF成功率差异有统计学意义（P〈0．05）。结论①对于不稳定多形性室速、无脉性室速、室扑，应首选150J的能量DF；②VF波的频率和振幅呈正相关性，随着VF时间的延长，VF波的频率和振幅会迅速同步变小；③VF波的振幅≤0．2mV或频率≤200次／min时，不适合直接DF，宜首选2min的标准CPR等处理措施，待VF的振幅和频率达到一定的标准后再行DF；VF波为频率〉4007X／min或振幅〉0．6mV时，宜首选150J直接DF；当VF波频率为200-400次／min或振幅为0．2-0．6mV时，宜首选200J直接DF。

Objective Searching the right defibrillation （DF） energy so that lessening DF injury for patients in the base of no reducing success rate of DF, and benefiting better therapy for patients of CPR success. Methods The type of DF instrument is biphasic truncated exponential waveform （BTE）. We Routinely note DF waveform of 93 eases needing emergent DF because of fast deadly arrhythmia in Critical - care medicine（ CCM ） of our hospital before each DF from Jan 2007 to Jan 2012, and choose 5 s waveform before DF as studying object. Then we systematically review and analyze DF energy, waveform of fast deadly arrhythmia, success rate of DF, and search for the relations of them. Results ①For no VF - fast deadly arrhythmia, we should choose 150 J for DF. The success rate of DF is very high, almost 100%. ②Frequency and amplitude of vibration of VF waveform take obviously on a relation of positive correlation. With time prolonging of VF, they fast synchronously become small. ③When frequency of VF isnl more than 200 bpm, or amplitude of vibration of VF not more than 0.2 mV, the success rate of DF for 150 J and 200 J all is very low, and it hasnt statistics difference between two groups. And in frequency 400 - 500 bpm and 〉 500 bpm two groups or amplitude of vibration 0.6-1.0 mV and 〉 1.0 mV two groups, the success rates of DF for 150 J and 200 J all are very high, and they have not statistics difference between two groups. Only when frequency of VF is among 200 - 400 bpm or amplitude of vibration of VF is among 0.2 -0.6 mV. the success rate of DF for 150 J and 200 Jhas statistics difference（P 〈 0.05 ）. Conclusion ① For no - VF fast deadly arrhythmia, we should first choose 150 J for DF. ②Frequency and amplitude of vibration of VF waveform take obviously on a relation of positive correlation. With time prolonging of VF, they fast synchronously become slow or small.③Frequency of VF ≤ 200 bpm, or amplitude of vibration of VF ≤ 0.2 mV doesn＇t adapt to immediate DF, and we may first choose normal CPR for 2 min. When frequency or amplitude of vibration of VF waveform accord with some standards, then we may choose to defibrillate. As frequency of VF 〉 400 bpm or amplitude of vibration of VF 〉0.6 mV, we should first choose 150 J for immediate DF. As frequency of VF among 200- 400 bpm or amplitude of vibration of VF among 0.2 - 0.6 mV, we should first choose 200J for immediate DF.