15例瓣膜置换患者术后永久起搏器的应用  

Permanent pacemaker implantation after valve replacement:Experience of 15 cases

作　　者：肖平喜[1] 胡作英[1] 翁川晴[1] 张航[1] 潘昌[1] 戴振林[1] 

机构地区：[1]南京医科大学附属南京第一医院心血管内科,南京医学博士210006

出　　处：《医学研究生学报》2011年第7期733-735,共3页Journal of Medical Postgraduates

基　　金：南京市卫生局青年科技人才启动项目(QYK09159)

摘　　要：目的越来越多的瓣膜病患者在接受开放手术后需要植入起搏器。文中通过分析1组瓣膜置换术后植入永久起搏器的瓣膜病患者临床资料,进而探讨瓣膜置换患者术后永久起搏器植入的方法及经验。方法连续选择2008年2月至2010年12月换瓣术后,因房室传导阻滞而需植入永久起搏器的15例患者。根据心律特点及患者经济情况选择双腔或单腔起搏器,术中利用已植入的人工瓣膜作为间隔部定位的参考,并评估导丝回撤前后电极位置的稳定性。比较该类患者在换瓣手术前后纽约心功能分级及超声指标。短期随访观察该组患者的起搏器参数情况。结果 15例患者手术全部成功。同非起搏依赖组相比,起搏依赖组换瓣术前Ⅱ度以上房室传导阻滞较多(P<0.05),心肺转流术时间较多(P<0.01)。起搏依赖组与非依赖组之间在性别、年龄、瓣膜疾病种类、起搏部位等方面无显著性差异。起搏依赖组术后1个月随访,除阻抗轻度增高外,阈值、感知较术后即刻均无显著改变。射血分数(ejection fraction,EF)值、左室舒张末径(left ventricular end-diastolicdimesion,LVEDD)等指标也无显著变化。所有间隔部起搏患者,术中使用人工瓣膜参考辅助电极定位,手术顺利完成。结论换瓣术后永久起搏器植入安全、有效。推测术前Ⅱ度以上房室传导系统疾病、较长时间的心肺转流术等是换瓣术后起搏依赖的危险因素。参考人工瓣膜辅助电极定位可成为起搏器植入术中新的间隔部定位方法。Objective After cardiac valve replacement,patients might have the opportunity of suffering from conduction abnormities.There is now still some controversy about the diagnosis and treatment of this disease.We here retrospectively studied 15 cases of permanent pacemaker implantation after cardiac valve replacement,to explore the experience of cardiac pacing in those patients.Methods Fifteen consecutive patients with atrioventricular block after valve replacement were selected in this study,which accepted permanent pacemaker implantation(PPI) at their post-surgery period.They received VVI or DDD mode cardiac pacing according one′s cardiac rhythm or economic status,and so did the location of electrode,whose demographic data was recorded.After the implantation,one month's follow-up was carried out,their NYHA heart function was classified.What′s more,their pacing reference,their electrocardiograhy indicators,such as EF fraction and LVEDD,were analyzed.Results All operations were successful in 15 patients,10 of which received VVI mode pacing,and the other DDD mode.Compared with non-pacemaker dependent(NP) group,pacemaker dependent(P) group presented a higher incidence of conduction disease(P<0.05) and longer cardiopulmonary bypass time(CPB)(P<0.01).Before,right after,one week and one month after cardiac pacing,no significant difference was found in such indexes as NYHA heart function,LVEDD,EF and pacing threshold and sensing.In all septal-location cases,the prothetic vlave was used as an 'image navigation' tool for the accurate and smooth location of the active electrode.Conclusion Permanent pacemaker implantation after valve replacement was safe and effective.Already existing conduction disease(grade II and up),longer CPB time might be risk factors of later pacemaker dependency in valve replacement patients.Take advantage of the good visibility of prosthetic valve may be a novel way for the electrode′s septal location.

关 键 词：心脏起搏 心脏瓣膜置换术 心律失常 

分 类 号：R65[医药卫生—外科学]