当前课程知识点:Medical Nursing > Unit 4 Care of Patients with Cardiovascular System Diseases (Part One) > Chapter 3 Care of Patients with Arrhythmia > Atrial fibrillation
大家好 这讲我们学习心房颤动
首先来看概念
心房颤动简称房颤
是一种十分常见的心律失常
发病率随年龄增长而增加
病因
房颤常发生于有器质性心脏病病人
如风湿性心脏病 冠心病
高血压性心脏病 甲状腺功能亢进性心脏病
缩窄性心包炎 心肌病
感染性心内膜炎及慢性肺源性心脏病等
正常人在情绪激动
运动或急性乙醇中毒时可发生房颤
临床表现
房颤症状在很大程度上取决于心室率快慢
以及基础心脏病的严重程度
可出现以下不同表现
1.心室率接近正常时可无症状
2阵发或初发心室率较快时
患者感心悸 胸闷
心室率超过150次/分时
可诱发心绞痛或心力衰竭
3.血栓栓塞 房颤可以血栓栓塞并发症为首发表现
心脏听诊第一心音强弱不等
心律极不规则
当心室率快时可有脉搏短绌
目前 临床上多采用3P分类法
将房颤分为阵发性 持续性与永久性三类
1)阵发性房颤 通常在48h之内 能自行终止 反复发作
2)持续性房颤 持续时间>7天
多需药物或电复律恢复窦性心律
3)永久性房颤 房颤持续存在超过1年
已不可能恢复窦性心律
心电图特征
P波消失 代之以小而不规则的基线波动
形态与振幅均变化不定
称f波 频率 350~600 次/分
心室率通常在100~160 次/ 分
心室律极不规则
QRS 波群形态一般正常
当心室率过快 伴有室内差异性传导时
QRS 波群增宽变形
心房颤动如何治疗 主要以下几点
1)应积极寻找和治疗基础心脏病和诱发因素
2)控制心室率
可选用地高辛 β受体阻滞剂或钙通道阻滞剂
控制过快的心室率 维持静息时心率在60~80次/分
轻微活动控制在100次/分
3) 转复和维持窦性心律
药物复律
房颤发作在7天之内效果最好
成功率为30~80%
可选用普罗帕酮 索他洛尔 胺碘酮等进行复律
电复律 是安全有效的方法
成功率可达80%~95%
与药物联合应用时成功率几乎100%
阵发性快速心室率的房颤
伴有血流动力学障碍时
应立即电复律
电复律操作前应停用洋地黄至少24小时
纠正低钾血症 并空腹6小时以上
3)血栓栓塞的预防
无论是药物复律还是电复律均有引起血栓栓塞或脑卒中的危险
有研究表明
在复律前后给与抗凝治疗3~4周
危险性可降至1%以下
一般认为 房颤持续时间<48小时
血栓栓塞的危险性小 可不抗凝
房颤持续时间>48小时或时间不清楚者
均应在复律前抗凝3周 复律后抗凝4周
注意:
使凝血酶原时间国际标准化比值(INR)维持在2.0~3.0之间
能安全而有效预防脑卒中发生
关于房颤就讲到这里
谢谢大家
-Introduction to Medical Nursing
--Introduction to Medical Nursing
--Introduction to Medical Nursing
-Chapter 1 Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
-Chapter 2 Care of Patients with Pneumonia
--Overview of pneumonia
--Streptococcal Pneumonia
--Other types of pneumonia
--The quality and color of sputum
--Care of Patients with Pneumonia
-Chapter 3 Care of Patients with Lung Abscess
--Introduction of lung abscess
--Introduction of lung abscess
--Treatment and nursing of lung abscess
--Treatment and care of nursing abscess
--Care of Patients with Lung Abscess
-Chapter 4 Care of Patients with Pulmonary Tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (II)
--Clinical manifestation of pulmonary tuberculosis (II)
--Treatment and nursing of pulmonary tuberculosis
--Treatment and nursing of pulmonary tuberculosis
--Care of Patients with Pulmonary Tuberculosis
-Chapter 5 Care of Patients with Chronic Obstructive Pulmonary Disease
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Introduction of chronic obstructive pulmonary disease
--Introduction of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Oxygen
--Care of Patients with Chronic Obstructive Pulmonary Disease
-Chapter 6 Care of Patients with Bronchial Asthma
--Etiology and pathogenesis of bronchial asthma
--Etiology and pathogenesis of bronchial asthma
--Clinical manifestation of bronchial asthma
--Clinical manifestation of bronchial asthma
--Treatment and nursing of bronchial asthma
--Treatment and nursing of bronchial asthma
--Care of Patients with Bronchial Asthma
-Chapter 7 Care of Patients with Chronic Pulmonary Heart Disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Care of Patients with Chronic Pulmonary Heart Disease
-Chapter 8 Care of Patients with Primary Bronchogenic Carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Clinical manifestation and auxiliary examination
--Clinical manifestation and auxiliary examination
--Treatment and nursing of primary bronchogenic carcinoma
--Treatment and nursing of primary bronchogenic carcinoma
--Care of Patients with Primary Bronchogenic Carcinoma
-Chapter 9 Care of Patients with Pleural Effusion
--Etiology, pathogenesis and clinical manifestations
--Etiology, pathogenesis and clinical manifestations
--Treatment and nursing of pleural effusion
--Treatment and nursing of pleural effusion
--Determination of the nature of pleural effusion
--Care of Patients with Pleural Effusion
-Chapter 10 Care of Patients with Respiratory Failure and Acute Respiratory Distress Syndrome
--Etiology and pathogenesis of respiratory failure
--Etiology and pathogenesis of respiratory failure
--Treatment and nursing of respiratory failure patients
--Treatment and nursing of respiratory failure patients
--Care of Patients with Respiratory Failure
--Introduction of acute respiratory distress syndrome
--Introduction of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Care of Patients with Respiratory Failure
--Care of Patients with Acute Respiratory Distress Syndrome
-Unit Test: Respiratory System
-Unit Assignment: Respiratory System
-Chapter 1 Care of Patients with Cardiovascular System Diseases
--Overview of Cardiovascular System
--Overview of Cardiovascular System
--Overview of Cardiovascular System
-Chapter 2 Care of Patients with Heart Failure
--Overview of heart failure
--Chronic heart failure (1)
--Chronic heart failure (2)
--Acute heart failure
-Chapter 3 Care of Patients with Arrhythmia
--Overview of arrhythmia
--Sick sinus syndrome
--Supraventricular tachycardia
--Supraventricular tachycardia
--Atrial fibrillation
--Ventricular tachycardia
--Atrioventricular block
--Nursing care of patients with arrhythmia
--Nursing care of patients with arrhythmia
-Chapter 4 Care of Patients with Coronary Artery Disease
--Overview of coronary heart disease
--Overview of coronary heart disease
--Stable angina pectoris
--Unstable angina pectoris
--Acute myocardial infarction (1)
--Acute myocardial infarction (1)
--Acute myocardial infarction (2)
--Acute myocardial infarction (2)
--Acute myocardial infarction (3)
--Acute myocardial infarction (3)
--Difference between angina pectoris and myocardial infarction
-Chapter 5 Care of Patients with Hypertension
--Primary hypertension (1)
--Primary hypertension (2)
--Safe nursing for patients with hypertension
-Chapter 6 Care of Patients with Myocardial Diseases
--Myocardial Diseases (1)
--Myocardial Diseases (2)
--Myocardial Diseases (3)
-Unit Assignment: Cardiovascular System
-Chapter 1 Overview of Digestive System
--Overview of digestive system(I)
--Overview of digestive system(I)
--Overview of digestive system(II)
--Overview of digestive system(II)
--Overview of Digestive System
-Chapter 2 Care of Patients with Peptic Ulcer
--Etiology and clinical manifestation of peptic ulcer
--Etiology and clinical manifestation of peptic ulce
--Treatment and nursing of peptic ulcer
--Treatment and nursing of peptic ulcer
--Care of Patients with Peptic Ulcer
-Chapter 3 Care of Patients with Hepatic Cirrhosis
--Etiology and clinical manifestation of hepatic cirrhosis
--Etiology and clinical manifestation of hepatic cir
--Treatment and nursing of hepatic cirrhosis
--Treatment and nursing of hepatic cirrhosis
--Care of Patients with Hepatic Cirrhosis
-Chapter 4 Care of Patients with Hepatic Encephalopathy
--Etiology and pathogenesis of hepatic encephalopathy
--Etiology and pathogenesis of hepatic encephalopath
--Clinical manifestation,treatment and nursing of hepatic encephalopathy
--Clinical manifestation,treatment and nursing of he
-- Care of Patients with Hepatic Encephalopathy
-Chapter 5 Care of Patients with Upper Gastrointestinal Hemorrhage
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage
--Care of Patients with Upper Gastrointestinal Hemorrhage
-Unit Test: Digestive System
-Unit Assignment: Digestive System
-Chapter 1 Overview of Urinary System
--Overview of Urinary System
-Chapter 2 Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Acute Glomerulonephritis
-- Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Chronic Glomerulonephritis
-Chapter 3 Care of Patients with Nephrotic Syndrome
--Nephrotic Syndrome
-Chapter 4 Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
-Chapter 5 Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Unit Assignment: Urinary System
-Chapter 6 Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
-Chapter 1 Overview of Hematologic System
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
-Chapter 2 Overview of Anemia
--Overview of Anemia
-Chapter 3 Care of Patients with Iron Deficiency Anemia
--Overview,etiology and pathogenesis,clinical manifestation,auxiliary examination and diagnosis of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
-Chapter 4 Care of Patients with Aplastic Anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Treatment and nursing of aplastic anemia
--Treatment and nursing of aplastic anemia
--Care of Patients with Aplastic Anemia
-Chapter 5 Care of Patients with Hemolytic Anemia
--Nursing of patients with hemolytic anemia
--Nursing of patients with hemolytic anemia
--Care of Patients with Hemolytic Anemia
-Chapter 6 Care of Patients with Hemorrhagic Diseases
--Overview of hemorrhagic diseases
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
--Nursing of patients with anaphylactoid purpura
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
-Chapter 7 Care of Patients with Leukemia
--Definition, etiology and classification of leukemia
--Definition, etiology and classification of leukemia
--Definition and clinical manifestation of acute leukemia
--Definition and clinical manifestation of acute leukemia
--Auxiliary examination of acute leukemia
--Auxiliary examination of acute leukemia
--Nursing of acute leukemia(I)
--Nursing of acute leukemia(II)
--Nursing of acute leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Care of Patients with Leukemia
-Chapter 8 Care of Patients with Lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Care of Patients with Lymphoma
-Unit Test: Hematologic System
-Unit Assignment: Hematologic System
-Chapter1 Overview of Endocrine ystem
--Overview of Endocrine System
--Overview of Endocrine System
--Overview of Endocrine System
-Chapter2 Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 2
--Care of Patients with Hypercortisolism2
--Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism
-Chapter3 Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism
-Chapter4 Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus1
--Care of Patients with Diabetes Mellitus 1
--Care of Patients with Diabetes Mellitus2
--Care of Patients with Diabetes Mellitus 2
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus
-Unit Review: Endocrine System
--Unit Assignment: Endocrine System
--Unit Test: Endocrine System
-Chapter 1 Overview of Infectious Diseases
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases
-Chapter 2 Care of Patients with Viral Hepatitis
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis
-Chapter 3 Care of Patients with Hemorrhagic Fever with Renal Syndrome
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
-Chapter 4 Care of Patients with Acquired Immune Deficiency Syndrome
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
-Chapter 5 Care of Patients with Rabies
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies
-Chapter 6 Care of Patients with Epidemic Encephalitis B
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B
-Chapter 7 Care of Patients with Epidemic Cerebrospinal Meningitis
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis
-Chapter 8 Care of Patients with Cholera
--Care of Patients with Cholera
--Care of Patients with Cholera
--Care for patients with cholera
-Chapter 9 Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
-Chapter 10 Care of Patients with Schistosomiasis
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 2
--Care of Patients with Schistosomiasis 2
--Care for patients with schistosome
-Chapter 11 Care of Patients with COVID-19
--Care of Patients with COVID-19
--Care of Patients with COVID-19
-Chapter 12 Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
-Unit Test: Infectious Diseases
--Unit Test: infective disease
-Unit Assignment: Infectious Diseases
--Unit Assignment: Infectious Diseases
-Chapter 1 Overview of Nervous System Diseases
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
-Chapter 2 Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
-Chapter 3 Care of Patients with Cerebrovascular Diseases (Episode 1)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Intracerebral Hemorrhage(I)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
-Chapter 4 Care of Patients with Cerebrovascular Diseases (Episode 2)
--Subarachnoid Hemorrhage
--Transient Ischemic Attack
--Cerebral Thrombosis(I)
--Cerebral Thrombosis(II)
-Chapter 5 Care of Patients with Epilepsy
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy
-Chapter 6 Care of Patients with Parkinson Disease
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease
-Unit Assignment: Nervous System
--Unit Assignment: Nervous System