Geuze R H, de Feijter P J
J Electrocardiol. 1985 Jul;18(3):251-8. doi: 10.1016/s0022-0736(85)80049-2.
In a five year prospective study, transthoracic countershock of patients in the coronary care unit was evaluated with respect to efficacy, transthoracic resistance and arrhythmias. Those patients dying within 12 hours of the recorded event are referred to as agonal patients. Atrial arrhythmias were generally first treated with quinidine or disopyramide and/or a digitalis preparation. Patients with coronary heart disease were treated with lidocaine, disopyramide, or verapamil when there was time for appropriate diagnosis. The efficacy of the first shock with an energy level between 50 J and 200 J in non-agonal patients was: for atrial fibrillation, 44% (N = 34), and between 83% and 93% for tachycardias and ventricular fibrillation. The cumulative efficacy of two shocks with energy levels between 50 J and 200 J was: in atrial fibrillation 53% and others between 90% and 96%. In agonal patients with ventricular fibrillation and acute myocardial infarction the efficacy of one shock of 100-150 J was 39% and two shocks of 100-200 J, 69% (N = 13). No correlation was found between the transthoracic resistance and parameters such as body-weight, length or thorax-circumference, indicating that these should not be taken into account in the choice of the energy level for countershock. In non-agonal patients without coronary heart disease arrhythmias due to countershock increased in duration when the energy of the countershock increased (p less than 0.01, N = 39). It is concluded that the initial stored energy for defibrillation and cardioversion of nonagonal patients in a coronary care unit may be limited to 200 J (160 J delivered energy), even with atrial fibrillation after drug therapy in which case an initial energy level of 200 J seems more appropriate.
在一项为期五年的前瞻性研究中，对冠心病监护病房患者的经胸除颤在疗效、经胸电阻和心律失常方面进行了评估。在记录事件后12小时内死亡的患者被称为濒死患者。房性心律失常通常首先用奎尼丁或丙吡胺和/或洋地黄制剂治疗。冠心病患者在有时间进行适当诊断时，用利多卡因、丙吡胺或维拉帕米治疗。在非濒死患者中，能量水平在50焦耳至200焦耳之间的首次电击的疗效为：房颤为44%（N = 34），心动过速和室颤为83%至93%。能量水平在50焦耳至200焦耳之间的两次电击的累积疗效为：房颤为53%，其他为90%至96%。在濒死的室颤和急性心肌梗死患者中，100 - 150焦耳单次电击的疗效为39%，100 - 200焦耳两次电击的疗效为69%（N = 13）。未发现经胸电阻与体重、身高或胸围等参数之间存在相关性，这表明在选择除颤能量水平时不应考虑这些因素。在无冠心病的非濒死患者中，除颤引起的心律失常持续时间随除颤能量增加而延长（p < 0.01，N = 39）。得出的结论是，冠心病监护病房中非濒死患者除颤和心脏复律的初始储能可限制在200焦耳（释放能量160焦耳），即使是药物治疗后发生房颤的情况，此时初始能量水平200焦耳似乎更合适。
