儿科室颤和无脉性室速的体外和体内双相直流电击剂量。
External and internal biphasic direct current shock doses for pediatric ventricular fibrillation and pulseless ventricular tachycardia.
机构信息
Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
出版信息
Pediatr Crit Care Med. 2011 Jan;12(1):14-20. doi: 10.1097/PCC.0b013e3181dbb4fc.
OBJECTIVE
To determine energy dose and number of biphasic direct current shocks for pediatric ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
DESIGN
Observation of preshock and postshock rhythms, energy doses, and number of shocks.
SETTING
Pediatric hospital.
PATIENTS
Shockable ventricular dysrhythmias.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Forty-eight patients with VF or pulseless VT received external shock at 1.7 ± 0.8 (mean ± SD) J/kg. Return of spontaneous circulation (ROSC) occurred in 23 (48%) patients with 2.0 ± 1.0 J/kg, but 25 (52%) patients remained in VF after 1.5 ± 0.7 J/kg (p = .05). In 24 non-responding patients, additional 1-8 shocks (final dose, 2.8 ± 1.2 J/kg) achieved ROSC in 14 (58%) with 2.6 ± 1.1 J/kg but not in 10 (42%) with 3.2 ± 1.2 J/kg (not significant). Overall, 37 (77%) patients achieved ROSC with 2.2 ± 1.1 J/kg (range, 0.5-5.0 J/kg). Eight patients without ROSC recovered with cardiopulmonary bypass and internal direct current shock. At 13 subsequent episodes of VF or VT among eight patients, five achieved ROSC and survived. In combined first and subsequent resuscitative episodes, doses in the range of 2.5 to < 3 J/kg achieved most cases of ROSC. Survival for > 1 yr was seen in 28 (78%) of 36 patients with VF and seven (58%) of 11 patients with VT, with 35 (73%) overall. Lack of ROSC was associated with multiple shocks (p = .003). Repeated shocks with adhesive pads had significantly less impedance (p < .001). Pads in an anteroposterior position achieved highest ROSC rate. Internal shock for another 48 patients with VF or VT achieved ROSC in 28 (58%) patients with 0.7 ± 0.4 J/kg but not in 20 patients with 0.4 ± 0.3 J/kg (p = .01). Nineteen of the nonresponders who received additional internal 1-9 shocks at 0.6 ± 0.5 J/kg and one patient given extracorporeal membrane oxygenation all recovered, yielding 100% ROSC, but 1-yr survival tallied 43 (90%) patients.
CONCLUSIONS
The initial biphasic direct current external shock dose of 2 J/kg for VF or pulseless VT is inadequate. Appropriate doses for initial and subsequent shocks seem to be in the range of 3-5 J/kg. Multiple shocks do not favor ROSC. The dose for internal shock is 0.6-0.7 J/kg.
目的
确定小儿室颤（VF）和无脉性室性心动过速（VT）的双相直流电能量剂量和冲击次数。
设计
观察预激和后激节律、能量剂量和冲击次数。
地点
儿科医院。
患者
可电击性室性心律失常。
干预措施
无。
测量和主要结果
48 例 VF 或无脉性 VT 患者接受 1.7±0.8（均值±标准差）J/kg 的体外电击。23（48%）例患者以 2.0±1.0 J/kg 恢复自主循环（ROSC），但 25（52%）例患者以 1.5±0.7 J/kg 电击后仍持续 VF（p=0.05）。在 24 例无反应的患者中，给予 1-8 次附加冲击（最终剂量 2.8±1.2 J/kg），以 2.6±1.1 J/kg 获得 ROSC 14（58%）例，但以 3.2±1.2 J/kg 则未获得 10（42%）例（无显著差异）。总体而言，以 2.2±1.1 J/kg（范围 0.5-5.0 J/kg）获得 ROSC 的患者为 37（77%）例。8 例无 ROSC 的患者接受心肺旁路和内部直流电冲击后恢复。在 8 例患者中的 13 例随后的 VF 或 VT 发作中，5 例获得 ROSC 并存活。在 8 例患者的首次和随后的复苏发作中，2.5 至<3 J/kg 的剂量可使大多数患者获得 ROSC。VF 患者中存活>1 年的有 28（78%）例，VT 患者中有 7（58%）例，总计 35（73%）例。无 ROSC 与多次冲击有关（p=0.003）。使用粘性电极片进行重复冲击时，阻抗显著降低（p<0.001）。前后位电极片可获得最高的 ROSC 率。对 48 例 VF 或 VT 患者给予 0.7±0.4 J/kg 的额外内部冲击，28（58%）例患者获得 ROSC，但对 20 例接受 0.4±0.3 J/kg 冲击的患者则无（p=0.01）。19 例无反应患者给予 0.6±0.5 J/kg 的额外内部 1-9 次冲击和 1 例给予体外膜氧合治疗的患者均恢复，获得 100%的 ROSC，但 1 年生存率为 43（90%）例。
结论
VF 或无脉性 VT 的初始双相直流电外部冲击剂量 2 J/kg 不足。初始和随后冲击的适当剂量似乎在 3-5 J/kg 范围内。多次冲击不利于 ROSC。内部冲击剂量为 0.6-0.7 J/kg。
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