Sharma A D, Klein G J
University of Western Ontario, London, Canada.
Crit Care Clin. 1985 Nov;1(3):677-97.
The general principles that apply to treatment of arrhythmias in the critically ill include, first, an immediate correction of arrhythmias that result in hemodynamic deterioration. This more frequently necessitates DC cardioversion, pacing, or intravenous therapy than is seen in an otherwise healthy patient. Second, having resuscitated the patient and treated the arrhythmia, the physician should be acutely aware of any precipitating factors, which should then be corrected in order to prevent recurrence of the arrhythmia. Third, the physician should also be aware of the potential proarrhythmic effects of his or her antiarrhythmic drug therapy and be prepared to withdraw therapy when it appears that the arrhythmia has worsened following drug treatment. In the future, new technologic developments, including improved defibrillation systems, intracardiac catheters for defibrillation, and automatic arrhythmia detectors using intravascular catheters, may aid in the diagnosis and treatment of recurrent arrhythmias in the critically ill.
首先，立即纠正导致血流动力学恶化的心律失常。与健康患者相比，这更常需要直流电复律、起搏或静脉治疗。其次，在使患者复苏并治疗心律失常后，医生应敏锐地意识到任何促发因素，然后应予以纠正以防止心律失常复发。第三，医生还应意识到其抗心律失常药物治疗的潜在促心律失常作用，并准备好在药物治疗后心律失常似乎恶化时停用治疗。未来，新技术的发展，包括改进的除颤系统、用于除颤的心内导管以及使用血管内导管的自动心律失常检测器，可能有助于危重症患者复发性心律失常的诊断和治疗。
