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ChapterBasicPrinciplesofPacing第章起搏基本原理TheaimofthischapteristogivesufficientbackgroundandinformationaboutcardiacpacemakerstoallowinterpretationofECGsandtelemetrystripsofnormalpacemakerbehavior;tounderstandtheindicationsandutilityofacardiacpacemaker;tobefamiliarwiththecodingsystembywhichpacemakermodesaredetermined;toknowwhatapacedECGlookslikeandtobefamiliarwiththedifferenttypesofemergencypacing.
本章旨在描述起搏器基本知识，以便解释起搏心电图、远程心电图，了解起搏器的应用与适应证，熟悉起搏器编码系统及其起搏模式，认识各种包括紧急起搏的起搏器心电图。
一、Whatsthepacemaker？什么是起搏器？
Apacemakerrefersamedicalartificialdevicewhichdeliverselectricalimpulsesthroughelectrodestostimulatetheheartinordertoregulateitsrateandrhythm.Itisprimarilyusedtotreatseverebradycardiaresultedfromabnormalsinoatrialnodefunctionorimpairedorabsentconductionthroughtheatrioventricularnode.modernartificialpacemakersareprogrammableexternallyandselectablemodesfortheindividualpatient.apacemakeranddefibrillatorcanbeassembledtogetherinasingleimplantabledeviceforbothpacinganddefibrillation.someemploymultipleelectrodestostimulatedifferentpositionsinthehearttoimprovesynchronizationofthecardiacchambers.何谓起搏器?即是一种人工医学装置，通过电极释放脉冲刺激心脏以调节心率和节律。主要用来治疗因窦房结和房室结功能异常所致的严重心动过缓。当代起搏器可为每个病人做体外程序设计和选择起搏模式。起搏器和除颤器可组装一起，既可起搏又可除颤。有些且用多电极刺激心脏不同部位以达心脏同步功能。二、Whataretheworkingprinciplesofapacemaker？何为起搏器做功原理？Itisaprocessthatapacemakerdeliversstimulustodepolarizeachamberorinhibitsstimulationaccordingtotheindicationscontrolledbyitssensor.Asinglechamberpacemakermaydeliverstimulationinafixedrate.While,apacingchamber,sensorsensingandpacingresponseconstitutetheworkingprincipleofadualchamberpacemaker.这是一个全过程，即起搏器根据其感知器指令释放刺激除极心腔，或抑制刺激。单腔起搏器可能按固定频率释放刺激，而双腔起搏器的做功原理由起搏心腔、感知器感知，以及起搏应答所组成。.Pacingchambers起搏腔室Wheredoesapacemakerpace?Apacemakermaypaceeitheratriumorventricle,orboth.Ifapacemakerpacesonlyonechamber,itiscalledsinglechamberpacing,whichisasynchronouspacing.Ifapacemakerpacesboththeatriumandventriclesequentially,itisconsidereddual-chamberpacing.ItisAVsynchronouspacingthathasphysiologicallysuperiorastheatrialcontractionisrestored.起搏器起搏什么部位呢？起搏器可以是心房或心室起搏，也可以是心房和心室起搏。如果起搏器只起搏一个心腔，称为单腔起搏，此系非同步起搏。如果起搏器顺序起搏心房和心室，则称为双腔起搏，系同步起搏。随着心房收缩的恢复，房室同步起搏具有生理上的优越性。2、Sensorsensing感知器感知Howcanapacemakerknowwhentheheartneedspacing?Asensorinapacemakerisabletosenseanintrinsiccardiacactivityandrespondsuitably,eitherresultinginpacingorwithholdinsynchronywiththeintrinsicheartrhythm.起搏器如何知道何时心脏需要起搏？起搏器里面的感知器能感知心脏固有活动，做出起搏或者保持与固有心律同步的恰当反应。3、Pacingresponse起搏回应Howdoesapacemakerhaveresponsetothesensing?Basically,apacemakerrespondstosensingintwowaysbywhichitinitiatesimpulses:triggeringandinhibition.起搏器是如何对感知做出反应的？基本上，起搏器对感知的反应有两种方式：触发和抑制。（）Triggering,apacemakerpaceswheneveranintrinsicorpacedactivityissensed.Thisismost