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心房颤动的药物治疗 (规范化建议) PowerPoint PPT Presentation


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心房颤动的药物治疗 (规范化建议). 房 颤 概 述. 70%  发生于器质性心脏病患者 30%  无可察觉的心脏病和其他病因 孤立性房颤 ( lone 房颤) 特 发性房颤 ( idiopathic 房颤) 发病率随年龄递增: Framinghan 研究 20 岁以前  罕见 50-59 岁   0.5 % 80-89 岁   8.8 % 22 年累积发生率 男性: 2.2 % 女性: 1.7 %. 房 颤 的 后 果.

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心房颤动的药物治疗 (规范化建议)

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  • 70

  • 30

    lone

    idiopathic Framinghan20 5059 0.5%8089 8.8%

    222.2% 1.7%


1 CO

25-30%

2

5%2-7

1/6

  • 5-7


  • MVMIMS

    0.5- 1%

    10-15%

    4-5%

    50ASD54%

    20-25%


  • P

    1.paroxysm2-7

    24h

    2.persistent48h

    3.permanent




Pf

RRQRSQT


X



IC

Holter


QRS

PSVT

/



  • 1.

    2.

    3.

    4.


1

2

3


150mm

260/

3II

4f

5

6


  • (1)

    (2)

    (3)

    (4)


48h

48h

IaIcIII

(defibrillation threshold, DFT)

DFT


7

I A

a A

a A

b B

b B

b B

b C

A

C


7

I A

I A

I A

I A

IIa A

IIb B

IIb C

III A

III A


1.2-1.8g/d

10g0.2-0.4/d QTTdP()

30mg/kg

0.6-0.8/d

10g0.2-0.4/d

5-7mg/kg 30-60min1.2-1.8/d

10g0.2-0.4/d


8~30%

  • 20%

  • 3~7

  • 10~15%

    400mg/d 6


>60ml/min 0.5mg Bid QTTdP

40-60ml/min 0.25mg Bid

20-40ml/min 0.125mg Bid

<20ml/min

200-300mg LAV

1.5-3.0mg/kg 10-20min

1mg/10min QTTdP

1mg

450-600mg/kg 10-20min LAV

1.5-2.0mg/kg 10-20min

0.75-1.5 6-12h QTTdP


()

*R

150-200J(75%)360J

4

()

20J70~89R


  • 386%94%23%16%40%33%

  • ICD-


  • 1% 24h

  • 3WINR2.0~3.0 4W

    48hTEE

    INR2.0~3.0


1.({<24h} Ibutilid

iv C>70% )

2.DFT(III)

3.

4.

5./



  • HPHF>55>3


  • B-

  • Beta-blocker, Flecainide, PropafenoneSotalol


  • Amiodarone Dofetilide

  • Quinidine ProcainamideDisopyramideAmiodarone

  • Disopyramide

  • Propafenone


  • B-AmiodaroneSotalol

  • B-Amiodarone, SotalolIC

  • CADHF


  • QT

  • ICQRS<150%QRSIAIIIQTc<520ms

  • KMg

  • HF


  • Amiodarone: 100-400mg/dNTDP

  • Disopyramide: 400-750mg/dTDPHF

  • Dofetilide: 500-1000mg/dTDP

  • Procainamide: 1000-4000mg/dTDP


  • Flecainide: 200-300mg/dVTCHFAVN

  • Propenone: 450-900mg/dVTCHFAVN

  • Quinidine: 600-1500mg/dTDPAVN

  • Sotalol: 240-320mg/dTDPCHFCOPD



  • A

    TDPIAIII

    IC

    /VFQTIA

    ICIII

  • B

    IAICIII

    IC

    IC


  • C

    IAIC


  • 100%280%2-150-40%

  • Amiodarone, Flecainide, Ibutilide, Propafenone or and with Verapamil, Quinidine, Sotalol

  • 48


  • PR

    Flecainide, Propafenone, Sotalol,

    Amiodarone

  • QRS:

    Flecainide,Propafenone

  • QT:

    Sotalol,Amiodarone,Disopyramide


  • CHFCHFAmiodarone, Dofetilide

  • CADB-Sotalol, AmiodaroneDofetilideQuinidine, Procainamide, DisopyramideFlecainide, Propafenone


  • LVHTDPCADLVHFlecainide, PropafenoneAmiodarone, SotalolLVHDisopyramide, Quinidine, Procainamide

  • W-P-WRFCAB-Amiodarone,Propafenone


100-400mg/d

400-750mg/d TdpHF

500-1000mg/d Tdp

200-300mg/d VTCHFAVN

1000-4000mg/d Tdp

450-900mg/d VTCHFAVN

600-1500mg/d TdpCHFSB (-)

240-320mg/d


HF CAD HD

LVH(+) LVH(-)


1.

2.

3.


60~80/min

90~115/min


  • Diltiazem:0.25mg /kg >2min. )2-75-15mg/AVBHF (I)

  • Esmolol0.5mg/kg >1min) 5min0.05-0.2mg/kg/minAVBHFI

  • Metroprolol2.5mg-5mgIV >2min,5min(I)


  • Propranolol0.15mg/kg IV 5minAVBHF( I )

  • Verapamil0.075-0.15mg/kg >2min,3-5minAVBHF( I )

  • Digaoxin0.25mg IV /2 h 1.5mg2h 0.125-0.25mg/dAVB( IIb )


()

0.25mg/kg iv >2min 2-7min 5-15mg/h AVBHF I

0.5mg/kg >1min 5min 0.05-0.2mg/kg/minAVBSBHF I

2.5-5mg/kg>2min 5min NA AVBSBHF I

0.15mg/Kg 5min NA AVBSBHF I

0.075-0.15mg/kg >2min 3-5min NA AVBSBHF I

0.25mg/2h1.5mg 2h 0.15-0.25mg/d AVBSB IIb

*3 NA=not applicable


  • Digaoxin 0.25mg/2h 2h1.5mg 2h0.125-0.375mg/dI

  • DiltiazemNA2-4h120-360mg/d BID-TID I

  • Metroprolol NA 4- 6h25-100mg BIDI


  • PropranololNA 60-90min 80-240mg/dI

  • VerapamilNA 1-2h120-360mg/dI

  • Amiodarone800mg 1wk600mg 1wk400mg 4-6wk 1-3 wk 200mg/dIIb)


0.25mg q.2.h.po.1.5mg 2h 0.125-0.375mg/d AVBSB I

NA 2-4h 120-360mg/d AVBSB I

NA 4-6h 25-100mg Bid AVBSB I

NA 60-90min 80-240mg/d AVBSB I

NA 1-2h 120-360mg/d AVBSB I

600mg/d 7 1-3 200mg/d IIb

400mg/d7


  • 5mg+20ml iv

    10mg iv

    0.1mg/kg 20mliv

    0.4mg+20ml iv


  • 60-80/90-115/

  • IIII( 70mg 150mg iv)


A

A

/ A

BBs / B

/ a B


  • 48h15%transesophagealechocardiogram,TEE)

  • 65~75 TIA 45mm UCG25% TEE()


>75 65-75 <65

SP* 75

SBP>160mmHg

65 <65

*Stroke Prevention in Atrial Fibrillation


<60(Lone ) 325mg/d

<60 325mg/d

60 325mg/d

60CAD (INR2.0-3.0)

b

81-162mg/d

75 INR2.0

HF INR2.0-3.0


EF0.35

() INR 2.5-3.5

TEE


Vit K

II


  • INR2.0-3.0

    325mg/d

INR3.0-4.0


  • 1

    55mm

  • 2

    48

    34

  • 3


10% 4% 6%

2% 1% 1%

  • 75


199811ACCP

65

66-75

75


1.3mg75

2mg

2.

international

normalized ratioINR2.0-

3.0

3.3INR31/

INR1/446

4.INR 1.50.5mg/ ,INR

.-INR


5.5%-20%1/3

6.75

75

INR1.5-2.5

  • 300-325mg


INR

  • INRINR5-93-4INRK190%INR244

  • K1/1-2.5mg

  • K1 10mg)INR

  • INR 1.0~1.5

    4~5


(1)

(2)

(LMWH)


LMWH

(1)

(2)(>90%)

(3)(1-2/)

(4)()

(5)

(6)


Thank YOU !!!


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