中国床旁临时心脏起搏急诊专家共识(2023)  

Chinese emergency expert consensus on bedside temporary cardiac pacing(2023)

作　　者：中华医学会急诊医学分会 床旁临时心脏起搏急诊专家共识组 韩小彤[2] 祝益民 吕传柱 张国强[5] 刘猛[6] 肖雯 樊麦英[6] Emergency Medicine Branch of Chinese Medical Association;Bedside Temporary Cardiac Pacing Consensus Emergency Expert Group;Han Xiaotong;Zhu Yimin;Lyu Chuanzhu;Zhang Guoqiang(不详;Department of Emergency,Hunan Provincial People's Hospital(First Affiliated Hospital of Hunan Normal University),Changsha 410005,Hunan,China;Hunan Provincial Emergency Research Institute,Changsha 410005,Hunan,China;Department of Emergency,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu 610072,Sichuan,China;Department of Emergency,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]不详 [2]湖南省人民医院(湖南师范大学附属第一医院)急诊科,长沙410005 [3]湖南省急救研究所,长沙410005 [4]四川省医学科学院·四川省人民医院急诊科,成都610072 [5]中日友好医院急诊科,北京100029 [6]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,湖南省急危重症临床医学研究中心

出　　处：《中华危重病急救医学》2023年第7期678-683,共6页Chinese Critical Care Medicine

基　　金：湖南省科技创新重大项目(2020SK1011)。

摘　　要：临时心脏起搏是涉及危急心律失常诊治的一项必要技术,由于其紧急性、复杂性及不确定性,制订基于循证医学的急诊操作规范显得十分必要。目前国内外尚无专门的应用指南,中华医学会急诊医学分会组织相关专家起草了《中国床旁临时心脏起搏急诊专家共识(2023)》,以期规范与引导床旁临时心脏起搏的操作与应用。共识的制订采用共识会议法及美国牛津循证医学中心的证据分级和推荐依据,从床旁临时心脏起搏的方式、经静脉临时心脏起搏穿刺部位、导线的选择、置入位置、置入方式、起搏器参数设置、适应证、并发症及术后管理等方面进行了讨论,共提炼出13条推荐意见。共识推荐包括:经胸壁起搏与经静脉临时心脏起搏的选择;穿刺首选静脉;床旁起搏电极植入的靶目标及最佳引导方式;起搏器默认设置推荐;对于窦房结功能不全、房室传导阻滞、急性心肌梗死、心搏骤停、室性与室上性心律失常的应用推荐;超声引导与缩短临时起搏时间以降低经静脉临时心脏起搏的并发症;经静脉临时心脏起搏术后卧床及抗凝推荐;床旁临时心脏起搏总体安全有效;准确的病情评估;选择正确的急诊床旁临时起搏方案;及时的床旁临时心脏起搏能进一步提高急诊相关患者的生存率及改善预后。Temporary cardiac pacing is an essential technique in the diagnosis and treatment of arrhythmias. Due to its urgency, complexity, and uncertainty, it is necessary to develop an evidence-based emergency operation norms. Currently, there is no specific consensus guidelines at home or abroad. The Emergency Branch of Chinese Medical Association organized relevant experts to draft the Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) to guide the operation and application of bedside cardiac pacing. The formulation of the consensus adopts the consensus meeting method and the evidentiary basis and recommendation grading of the Oxford Center for Evidence-based Medicine in the United States. A total of 13 recommendations were extracted from the discussion on the methods of bedside temporary cardiac pacing, the puncture site of transvenous temporary cardiac pacing, the selection of leads, the placement and placement of leads, pacemaker parameter settings, indications, complications and postoperative management. The recommended consensus includes the choice between transcutaneous and transvenous pacing, preferred venous access for temporary transvenous pacing, the target and best guidance method for implantation of bedside pacing electrodes, recommended default pacemaker settings, recommended indications for sinoatrial node dysfunction, atrioventricular block, acute myocardial infarction, cardiac arrest, ventricular and supraventricular arrhythmias. They also recommended ultrasound guidance and a shortened temporary pacing support time to reduce complications of temporary transvenous cardiac pacing, recommended bedrest, and anticoagulation after temporary transvenous pacing. Bedside temporary cardiac pacing is generally safe and effective. Accurate assessment, correct selection of the pacing mode, and timely performance of bedside temporary cardiac pacing can further improve the survival rate and prognosis of related emergency patients.

关 键 词：临时起搏器 临时心脏起搏 心律失常 心动过缓 

分 类 号：R541.7[医药卫生—心血管疾病]