Goodman Sergei, Weiss Yoram, Weissman Charles
Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
Curr Opin Crit Care. 2008 Oct;14(5):549-54. doi: 10.1097/MCC.0b013e32830a4c5d.
To explore recent findings on the treatment and outcome of cardiac arrhythmias and how they affect ICU activities.
The rate vs. rhythm control debate for the treatment of chronic atrial fibrillation continues. It is still unclear whether the postcardiac surgery inflammatory response contributes to the development of atrial fibrillation. In noncardiothoracic surgery/trauma patients hospitalized in an ICU, new-onset supraventricular arrhythmias are associated with markedly elevated mortality when compared with patients with a prior history of such arrhythmias and patients who do not develop arrhythmias. The onset of new supraventricular arrhythmias in such patients appears to be a manifestation of multiple system organ failure as it is closely associated with sepsis. Cardioversion of supraventricular arrhythmias with biphasic waveforms is being studied to determine whether it is more effective than cardioversion with monophasic waveforms.
Supraventricular arrhythmias, especially atrial fibrillation, occur frequently in ICU patients. Intensivists not only treat atrial fibrillation itself but also its complications and the complications of the therapies used to prevent these complications. In ICU patients, ventricular arrhythmias have ominous implications because they usually portend either a major cardiac or a systemic dysfunction or both.
探讨心律失常治疗及转归的最新研究结果，以及这些结果如何影响重症监护病房（ICU）的工作。
慢性心房颤动治疗中的心率控制与节律控制之争仍在继续。心脏手术后的炎症反应是否会导致心房颤动的发生仍不明确。在入住ICU的非心胸外科手术/创伤患者中，与有此类心律失常病史的患者及未发生心律失常的患者相比，新发室上性心律失常患者的死亡率显著升高。此类患者新发室上性心律失常的发生似乎是多系统器官功能衰竭的一种表现，因为它与脓毒症密切相关。目前正在研究使用双相波进行室上性心律失常的心脏复律，以确定其是否比单相波心脏复律更有效。
室上性心律失常，尤其是心房颤动，在ICU患者中很常见。重症监护医生不仅要治疗心房颤动本身，还要治疗其并发症以及用于预防这些并发症的治疗方法所引发的并发症。在ICU患者中，室性心律失常具有不祥的意义，因为它们通常预示着严重的心脏或全身功能障碍，或两者兼有。
