心脏双支传导阻滞患者围术期安置临时起搏器的必要性分析  

On inserting a temporary pacemaker for heart bifascicular block in perioperative period

作　　者：莫怀忠[1] 安裕文[1] 姚茵[1] 陈惠[1] 

机构地区：[1]贵阳医学院附属医院麻醉科,贵阳550004

出　　处：《第三军医大学学报》2007年第16期1612-1614,共3页Journal of Third Military Medical University

摘　　要：目的探讨心脏双支传导阻滞患者围术期安置临时起搏器的指征及临床意义。方法对40例术前合并心脏双支传导阻滞及1例特殊病例的围术期处理作回顾性分析。根据病史、临床表现、体能评估和测评房室传导功能将40例患者分为2组:术前预置起搏器组(P组,n=25)和未置起搏器组(N组,n=15),分析两组麻醉手术期间是否发生房室传导阻滞,起搏器的工作状况和心动过缓时阿托品的治疗效果。结果40例双支阻滞患者麻醉手术经过顺利,术中发生低血压和心动过缓时均对药物治疗有效,无1例发展为完全性房室传导阻滞。1例术前近期出现完全性左束支阻滞的患者暂缓麻醉和手术,最终因抢救无效短期内死亡,提示有心肌严重损害。结论术前无症状不伴有房室传导阻滞的慢性双支阻滞患者不必常规安装临时起搏器,食道心房起搏对评价房室传导功能有量化效果且简单易行。Objective To investigate the indications to use a temporary pacemaker for bifascicular block in perioperative period. Methods The treatment for 40 patients with heart bifascicular block and a special case were retrospectively studied. All cases, according to their disease history, clinical symptoms, physical ability and atrio-ventricular conduction ability, were divided into two groups： P group （prophylactic insertion of a temporary pacemaker） and N group （without inserting a pacemaker）. During operation, we observed whether atrio-ventricular block occurs, the performance of pacemaker and atropine＇ s therapeutic efficacy to bradycardia. Results Anesthesia was postponed in one case because of acute left bundle branch block （LBBB） and the patient died with severe myocardium damage soon after failed resuscitation. All other cases went through anesthesia and operation smoothly. Bradycardia and hypotension could be relieved somewhat by medication in operation, and no complete atrio-ventricular block developed. Conclusion There is no need inserting a temporary pacemaker for Transesophageal atrial pacing is an chronic bifascicular block if asymptomatic and no atrio-ventricular block. easy way to evaluate in quantification atrio-ventricular conduction ability.

关 键 词：双支传导阻滞 临时起搏器 食道心房起搏 

分 类 号：R541.760.5[医药卫生—心血管疾病] R614[医药卫生—内科学]