不同病因患者植入心脏永久性起搏器的临床观察
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摘要
目的对不同病因行心脏永久性起搏器植入的患者进行相关临床指标的观察与分析。方法根据病因将入选患者分成冠心病组(78例)、退行性变组(62例)和心脏术后组(30例)。观察三组患者右心室电极固定所需X线曝光时间、心室起搏参数和并发症等。结果心脏术后组与冠心病组、退行性变组在X线曝光时间、起搏阈值、感知、阻抗方面比较,差异均有统计学意义(P <0. 05)。三组均无严重并发症发生,但心脏术后组与冠心病组、退行性变组术后一周内囊袋血肿发生率比较,差异有统计学意义(P <0. 05)。结论病因不同行永久性起搏器植入均安全有效,但因心脏手术引起传导功能异常,行起搏器植入术后囊袋血肿发生率高,其X线曝光时间及起搏的阈值、感知、阻抗值亦有所增加。
Objective To observe and analyze the clinical indexes of permanent pacemaker implanted in patients with different etiologies. Methods According to the etiology,the enrolled patients were divided into coronary-heartdisease group( 78 cases),degeneration group( 62 cases) and post-cardiac-surgery group( 30 cases). The duration of X-ray exposure for fixing right ventricular electrodes,ventricular pacing parameters and complications were observed among the three groups. Results The observation parameters including X-ray exposure time,pacing threshold,sensing and impedance of the post-cardiac-surgery group significantly varied from those of the coronary-heart-disease group and degeneration group( P < 0. 05). No serious complication occurred in the three groups. However,among the patients of the post-cardiac-surgery group,the incidence of pocket hematoma a week after operation was statistically significantly different from those of the coronary-heart-disease group and degeneration group( P < 0. 05). Conclusion Permanent pacemaker implantation for different etiologies all proves to be safe and effective. However,the incidence of cystic hematoma is high in the patients implanted with pacemakers for conduction dysfunction after cardiac surgery while the X-ray exposure time,pacing threshold,and perceptive function and impedance values also increased.
Objective To observe and analyze the clinical indexes of permanent pacemaker implanted in patients with different etiologies. Methods According to the etiology,the enrolled patients were divided into coronary-heartdisease group( 78 cases),degeneration group( 62 cases) and post-cardiac-surgery group( 30 cases). The duration of X-ray exposure for fixing right ventricular electrodes,ventricular pacing parameters and complications were observed among the three groups. Results The observation parameters including X-ray exposure time,pacing threshold,sensing and impedance of the post-cardiac-surgery group significantly varied from those of the coronary-heart-disease group and degeneration group( P < 0. 05). No serious complication occurred in the three groups. However,among the patients of the post-cardiac-surgery group,the incidence of pocket hematoma a week after operation was statistically significantly different from those of the coronary-heart-disease group and degeneration group( P < 0. 05). Conclusion Permanent pacemaker implantation for different etiologies all proves to be safe and effective. However,the incidence of cystic hematoma is high in the patients implanted with pacemakers for conduction dysfunction after cardiac surgery while the X-ray exposure time,pacing threshold,and perceptive function and impedance values also increased.
引文
[1]The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology(ESC).2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy[J].Rev Esp Cardiol(Engl Ed),2014,67(1):58.
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[3]乔青,徐伟.ACCF/AHA/HRS植入器械指南中普通起搏器植入适应证解读[J].中国介入心脏病学杂志,2014,22(9):611-612.
[4]程力,石翔.永久心脏起搏器植入术后电池耗竭一例[J].实用心电学杂志,2018,27(4):293-294.
[5]刘凡.心脏起搏器适应证变迁[J].现代电生理学杂志,2014,21(4):222-231.
[6]南征.心脏起搏器在缓慢性心律失常患者中的应用效果[J].中国实用医药,2014,9(32):78.
[7]邓晓奇,刘兴斌,刘汉雄,等.经锁骨下静脉与腋静脉途径植入心脏起搏电极的比较[J].中国心脏起搏与心电生理杂志,2014,28(3):240-242.
[8]Sharma G,Senguttuvan NB,Thachil A.A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided auxiliary vein technique for permanent pacemaker insertion[J].Can J Cardio,2012,28(5):542.
[9]姜东炬.双腔起搏器植入时锁骨下静脉一次穿刺两根鞘管输送电极技术改良介绍[J].中国介入心脏病学杂志,2014,22(4):272.
[10]周芳,尹春娥,王福军.双腔起搏器植入术后上腔静脉综合征一例[J].实用心电学杂志,2017,26(2):146-147.
[11]陈健.639例永久起搏器植入术后并发症原因及处理方法的分析[J].心脑血管病防治,2012,12(5):390-392.
[12]Bashir A,Noroozian N,Bradlow W.Malposition of pacing lead into the left ventricle’s rare complication of pacemaker insertion[J].BMJ Case Rep,2014,22(7):2021-2031.
[13]张博,江珊,刘华子.右室高位间隔部与心尖部VVI起搏对左心功能及三尖瓣返流影响的比较[J].心脏杂志,2013,25(5):561-563.
[14]郑晔,李永星,李哲,等.右室中位间隔起搏的可行性探讨[J].临床合理用药,2013,6(7):117-118.
[15]Saito Y,Nakamura K,Ito H.Cell based biologicalpace makers:progress and problems[J].Acta Med Okayama,2018,72(1):1-7.
[16]Stewart MH,Morin DP.Management of perioperative anticoagulation for device implantation[J].Card Electrophysiol Clin,2018,10(1):99-109.
[17]臧红云,王冬梅,韩雅玲,等.永久起搏器常见并发症的临床分析[J].中国实用内科杂志,2015,25(1):44-45.
[18]姚丙南,仇萍.永久起搏器术后少见并发症4例分析[J].实用心电学杂志,2018,27(2):128-130.
[2]张澍,华伟,黄得嘉,等.植入性心脏起搏治疗---目前认识和建议(2010修订版)[J].中华心律失常学杂志,2010,13(1):245-249.
[3]乔青,徐伟.ACCF/AHA/HRS植入器械指南中普通起搏器植入适应证解读[J].中国介入心脏病学杂志,2014,22(9):611-612.
[4]程力,石翔.永久心脏起搏器植入术后电池耗竭一例[J].实用心电学杂志,2018,27(4):293-294.
[5]刘凡.心脏起搏器适应证变迁[J].现代电生理学杂志,2014,21(4):222-231.
[6]南征.心脏起搏器在缓慢性心律失常患者中的应用效果[J].中国实用医药,2014,9(32):78.
[7]邓晓奇,刘兴斌,刘汉雄,等.经锁骨下静脉与腋静脉途径植入心脏起搏电极的比较[J].中国心脏起搏与心电生理杂志,2014,28(3):240-242.
[8]Sharma G,Senguttuvan NB,Thachil A.A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided auxiliary vein technique for permanent pacemaker insertion[J].Can J Cardio,2012,28(5):542.
[9]姜东炬.双腔起搏器植入时锁骨下静脉一次穿刺两根鞘管输送电极技术改良介绍[J].中国介入心脏病学杂志,2014,22(4):272.
[10]周芳,尹春娥,王福军.双腔起搏器植入术后上腔静脉综合征一例[J].实用心电学杂志,2017,26(2):146-147.
[11]陈健.639例永久起搏器植入术后并发症原因及处理方法的分析[J].心脑血管病防治,2012,12(5):390-392.
[12]Bashir A,Noroozian N,Bradlow W.Malposition of pacing lead into the left ventricle’s rare complication of pacemaker insertion[J].BMJ Case Rep,2014,22(7):2021-2031.
[13]张博,江珊,刘华子.右室高位间隔部与心尖部VVI起搏对左心功能及三尖瓣返流影响的比较[J].心脏杂志,2013,25(5):561-563.
[14]郑晔,李永星,李哲,等.右室中位间隔起搏的可行性探讨[J].临床合理用药,2013,6(7):117-118.
[15]Saito Y,Nakamura K,Ito H.Cell based biologicalpace makers:progress and problems[J].Acta Med Okayama,2018,72(1):1-7.
[16]Stewart MH,Morin DP.Management of perioperative anticoagulation for device implantation[J].Card Electrophysiol Clin,2018,10(1):99-109.
[17]臧红云,王冬梅,韩雅玲,等.永久起搏器常见并发症的临床分析[J].中国实用内科杂志,2015,25(1):44-45.
[18]姚丙南,仇萍.永久起搏器术后少见并发症4例分析[J].实用心电学杂志,2018,27(2):128-130.