Birkui P, Trigano J A, Degonde J
INSERM U141, Hôpital Lariboisière, Paris.
Bull Acad Natl Med. 1990 Dec;174(9):1361-70; discussion 1370-2.
Bradyarrhythmia or asystole is the most common rhythm disturbance with ventricular fibrillation and tachycardia, for 30-40% of patients admitted in intensive coronary care units. Already use in the therapy of bradyarrhythmia or asystole, as a method of emergency, immediately in place, the external pacing is very useful in an out of hospital therapy with personnel skilled in its use until the initiation of support therapy in coronary care units. Actually, with less significant side effects (no severe pain, no strong muscular contractions, no skin burns) and a best innocuity and tolerance based on the employment of larger adhesive pre-gelled patches, temporary transcutaneous cardiac stimulation is not only confined to unconscious patients but also in case of severe bradycardia, complete AV block in conscious patients. Our hemodynamic study shows a good level of systemic pressure and of cardiac index to permit the transport of patients in coronary care units in good conditions. Furthermore, the experimental study demonstrates the importance of the polarity of the electrodes and of the duration of the stimulus (more than 10 ms) to minimize the threshold (mA/cm2) so as to increase the tolerance in clinical application. Transcutaneous cardiac pacing is a simple and rapid pacing procedure with effective hemodynamic results for victims of out-of-hospital cardiac arrest and can be easily used in conscious patients without any complication.
缓慢性心律失常或心搏停止是重症冠心病监护病房30%-40%患者中最常见的心律失常，常伴有心室颤动和心动过速。作为一种紧急治疗方法，体外起搏已用于缓慢性心律失常或心搏停止的治疗，在现场立即使用，对于具备相关技能的人员而言，在院外治疗中直至冠心病监护病房开始支持治疗期间，体外起搏都非常有用。实际上，临时经皮心脏刺激的副作用较小（无剧痛、无强烈肌肉收缩、无皮肤灼伤），且基于使用更大的粘性预凝胶贴片，其安全性和耐受性最佳，不仅适用于昏迷患者，对于清醒患者出现严重心动过缓、完全性房室传导阻滞的情况也适用。我们的血流动力学研究表明，其能维持良好的体循环压力和心脏指数水平，从而使患者能在良好状态下转运至冠心病监护病房。此外，实验研究表明电极极性和刺激持续时间（超过10毫秒）对于将阈值（毫安/平方厘米）降至最低从而提高临床应用耐受性的重要性。经皮心脏起搏是一种简单快速的起搏程序，对于院外心脏骤停患者能产生有效的血流动力学效果，且可轻松用于清醒患者，无任何并发症。
