Pierce C D
Crit Care Nurs Clin North Am. 1989 Jun;1(2):423-35.
Transcutaneous cardiac pacing is an exciting alternative to invasive endocardial pacing methods for the treatment of hemodynamically significant bradyarrhythmias. Prompt institution of a pacing support system is crucial for improving outcomes in this patient population. Recent advances in technology and microcircuitry have eliminated the problems of painful, musculoskeletal stimulation and excessive distortion of the ECG signal associated with earlier devices. The ease of application and simplicity of operation associated with this technique make it ideally suitable for employment in the emergent situation, especially in the prehospital setting. The noninvasive nature of this technique is particularly beneficial for patients receiving thrombolytic therapy who are at risk for developing reperfusion dysrhythmias. Prophylactic use of transcutaneous pacemakers in a variety of clinical situations, such as atrioventricular blocks, may eliminate the need for transvenous electrode insertion and its related complications. A transcutaneous pacing system with the capability of functioning in the demand mode should be readily available in emergency rooms, intensive care units, and telemetry floors. Although unlikely to replace transvenous methods, the growing popularity of this technique has many implications for the nurse in the critical care setting.
对于血流动力学显著的缓慢性心律失常的治疗，经皮心脏起搏是侵入性心内膜起搏方法的一种令人兴奋的替代方法。迅速建立起搏支持系统对于改善该患者群体的治疗结果至关重要。技术和微电路方面的最新进展消除了与早期设备相关的疼痛、肌肉骨骼刺激以及心电图信号过度失真等问题。该技术应用简便、操作简单，使其非常适合在紧急情况下使用，尤其是在院前环境中。该技术的非侵入性对于接受溶栓治疗且有发生再灌注心律失常风险的患者特别有益。在各种临床情况（如房室传导阻滞）中预防性使用经皮起搏器，可能无需插入经静脉电极及其相关并发症。具备按需模式功能的经皮起搏系统应在急诊室、重症监护病房和遥测病房随时可用。尽管不太可能取代经静脉方法，但该技术日益普及对重症监护环境中的护士有诸多影响。
