心脏瓣膜置换术后患者植入起搏器的安全可行性研究及并发症预防
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摘要
目的探讨心脏瓣膜置换术后患者植入起搏器的安全可行性,以及预防其并发症发生的有效方法。方法对首都医科大学附属北京安贞医院2013年1月至2016年12月共计87例初次植入心脏起搏器患者的临床资料进行回顾性分析,根据是否为心脏瓣膜置换术后患者分为:瓣膜置换组23例,常规观察组64例。分析术中、术后起搏器阈值、感知情况,随访术中、术后7 d、3个月、半年穿刺并发症、电极脱位、感染等并发症情况。结果组术中、术后及长期随访结果显示总并发症发生共计8例,其中瓣膜置换组2例(8. 7%),常规观察组6例(9.4%)。其中与起搏器植入相关并发症气胸、血气胸、囊袋血肿、感染等共3例;与电极导线相关电极穿孔、绝缘层破损、脱位等共2例;与起搏器相关并发症起搏器移位、电池提前耗竭、起搏器感知、起搏障碍、起搏综合征等共3例。2组间并发症发生情况差异无统计学意义(P>0.05)。结论对于心脏瓣膜置换术后患者植入起搏器是安全可行性的,采用负压球囊加用凝血酶能减低术后感染以及出血的风险。
Objective To observe the safety and feasibility of cardiac pacemaker implantation in patients after valve replacement and to explore the preventive measures for surgical complications. Methods From January2013 to December 2016, clinical data of 87 patients who underwent primary cardiac pacemaker implantation in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Among them, 23 patients had previous cardiac valve replacement(valve replacement group) and 64 patients were routine group. Intraoperative and postoperative pacemaker threshold value and perception were measured. Intraoperative and postoperative 7 d,3-and 6-month puncture complications, electrode dislocation, infection and other surgical complications were observed.Results During operation and long-term follow-up, there were 8 complications in total, including 2 cases(8.7%) in the valve replacement group and 6 cases(9. 4%) in the routine group. There were 3 cases of complications related to pacemaker implantation such as pneumothorax, blood pneumothorax, pocket hematoma and infection. There were 2 cases of electrode perforation, insulation failure and dislocation. There were 3 cases of pacemaker-related complications including pacemaker displacement, battery depletion, pacemaker perception, pacing disorder and pacing syndrome. Incidence of complications was similar between groups(P>0. 05). Conclusions It is safe and feasible to implant pacemaker in patients after heart valve replacement. Negative pressure balloon combined with thrombin can reduce the risk of postoperative infection and bleeding.
Objective To observe the safety and feasibility of cardiac pacemaker implantation in patients after valve replacement and to explore the preventive measures for surgical complications. Methods From January2013 to December 2016, clinical data of 87 patients who underwent primary cardiac pacemaker implantation in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Among them, 23 patients had previous cardiac valve replacement(valve replacement group) and 64 patients were routine group. Intraoperative and postoperative pacemaker threshold value and perception were measured. Intraoperative and postoperative 7 d,3-and 6-month puncture complications, electrode dislocation, infection and other surgical complications were observed.Results During operation and long-term follow-up, there were 8 complications in total, including 2 cases(8.7%) in the valve replacement group and 6 cases(9. 4%) in the routine group. There were 3 cases of complications related to pacemaker implantation such as pneumothorax, blood pneumothorax, pocket hematoma and infection. There were 2 cases of electrode perforation, insulation failure and dislocation. There were 3 cases of pacemaker-related complications including pacemaker displacement, battery depletion, pacemaker perception, pacing disorder and pacing syndrome. Incidence of complications was similar between groups(P>0. 05). Conclusions It is safe and feasible to implant pacemaker in patients after heart valve replacement. Negative pressure balloon combined with thrombin can reduce the risk of postoperative infection and bleeding.
引文
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[5] Essebag V, Verma A, Healey JS, et al. Clinically significant pocket hematoma increases long-term risk of device infection:BRUISE CONTROL INFECTION study[J]. J Am Coll Cardiol,2016,67(11):1300-1308. DOI:10. 1016/j.jacc.2016.01.009.
[6] Polyzos KA, Konstantelias AA, Falagas ME, et al. Risk factors for cardiac implantable electronic device infection:a systematic review and meta-analysis[J]. Europace, 2015,17(5):767-777. DOI:10.1093/europace/euv053.
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[8] Opic P, van Kranenburg M, Yap SC, et al. Complications of pacemaker therapy in adults with congenital heart disease:a multicenter study[J]. Int J Cardiol, 2013,168(4):3212-3216. DOI:10. 1016/j. ijcard.2013.04. 114.
[9] Glikson M. Conservative treatment of pacemaker pocket infection:is it a viable option?[J]. Europace, 2013,15(4):474-475.DOI:10.1093/europace/eus372.
[10] Socie P, Nicot F, Baudinaud P, et al. Frequency of recovery from complete atrioventricular block after cardiac surgery[J]. Am J Cardiol, 2017,120(10):1841-1846. DOI:10. 1016/j. amjcard.2017.07.090.
[11] Miho T, Yoshikai M, Satoh H, et al. Tricuspid valve replacement without removing transvenous pacemaker lead[J]. Kyobu Geka,2017,70(7):493-496.
[12] Robich MP, Schiltz NK, Johnston DR, et al. Risk factors and outcomes of patients requiring a permanent pacemaker after aortic valve replacement in the United States[J]. J Card Surg, 2016,31(8):476-485. DOI:10. 1111/jocs. 12769.
[2]张澍,黄从新,黄德嘉.心电生理及心脏起搏专科医师培训教程[M].北京:人民卫生出版社,2007:551-560.Zhang S,Huang CX, Huang DJ. Training materials for electrocardiology and cardiac pacing[M]. Beijing:People's Medical PublishingHouse, 2007:551-560.
[3] Tan EM, Nagpal A, DeSimone DC, et al. Impacts of a care process model and inpatient electrophysiology service on cardiovascular implantable electronic device infections:a preliminary evaluation[J].J Interv Card Electrophysiol, 2017,50(1):117-124. DOI:10.1007/s10840-017-0282-2.
[4] Lakshmanadoss U, Nuanez B, Kutinsky I, et al. Incidence of pocket infection postcardiac device implantation using antibiotic versus saline solution for pocket irrigation[J]. Pacing Clin Electrophysiol, 2016,9(9):978-994. DOI:10.1111/pace. 12920.
[5] Essebag V, Verma A, Healey JS, et al. Clinically significant pocket hematoma increases long-term risk of device infection:BRUISE CONTROL INFECTION study[J]. J Am Coll Cardiol,2016,67(11):1300-1308. DOI:10. 1016/j.jacc.2016.01.009.
[6] Polyzos KA, Konstantelias AA, Falagas ME, et al. Risk factors for cardiac implantable electronic device infection:a systematic review and meta-analysis[J]. Europace, 2015,17(5):767-777. DOI:10.1093/europace/euv053.
[7] Rydlewska A, Za bek A, Malecka B, et al. Pacemaker pocket displacement as a symptom of lead dependent infective endocarditis[J].Kardiol Pol, 2013,71(9):960-962. DOI:10.5603/KP.2013.0234.
[8] Opic P, van Kranenburg M, Yap SC, et al. Complications of pacemaker therapy in adults with congenital heart disease:a multicenter study[J]. Int J Cardiol, 2013,168(4):3212-3216. DOI:10. 1016/j. ijcard.2013.04. 114.
[9] Glikson M. Conservative treatment of pacemaker pocket infection:is it a viable option?[J]. Europace, 2013,15(4):474-475.DOI:10.1093/europace/eus372.
[10] Socie P, Nicot F, Baudinaud P, et al. Frequency of recovery from complete atrioventricular block after cardiac surgery[J]. Am J Cardiol, 2017,120(10):1841-1846. DOI:10. 1016/j. amjcard.2017.07.090.
[11] Miho T, Yoshikai M, Satoh H, et al. Tricuspid valve replacement without removing transvenous pacemaker lead[J]. Kyobu Geka,2017,70(7):493-496.
[12] Robich MP, Schiltz NK, Johnston DR, et al. Risk factors and outcomes of patients requiring a permanent pacemaker after aortic valve replacement in the United States[J]. J Card Surg, 2016,31(8):476-485. DOI:10. 1111/jocs. 12769.