63例次永久起搏器更换术临床分析  

Reasons and complications of pacemaker replacement operation： clinical analysis of 69 case-times

作　　者：刘雪玲[1] 任利辉[1] 叶慧明[1] 

机构地区：[1]北京世纪坛医院心内科,100038

出　　处：《中华医学杂志》2008年第28期1989-1991,共3页National Medical Journal of China

摘　　要：目的分析永久起搏器更换原因及更换术并发症的防治对策，并探讨旧电极的处理方法。方法更换术病人57例，男38例，女19例，年龄74岁±8岁（56～94）岁，病态窦房结综合征31例，Ⅱ度和Ⅲ度房事传导阻滞26例。单腔起搏器49例，双腔起搏器8例，起搏器平均使用时间9．25（2～15）年。共更换63例次，其中更换电极13例次。结果起搏器更换术原因为起搏器电池自然耗竭57例次，电池提前耗竭2例，电极导线不全断裂2例，囊袋感染2例。更换术并发症9例，分别为囊袋血肿4例，电极脱位3例，废弃电极脱入右室2例。更换起搏器时起搏阈值[（0．77±0．40）V]比初次植入时的阈值[（0．60±0．21）V]明显高（P〈0．01）。更换时的电极阻抗[（854±136）Ω]、R波振幅[（12±4）mV]与植入时[（828±176）Ω、（12±4）mV]比较，差异无统计学意义（均P〉0．05）。结论起搏器更换主要原网为电池自然耗竭。经测试大部分心窀电极呵以继续使用。起搏器更换术严重的并发症是废弃电极脱入右室，正确的电极处理方法可以避免此类并发症的发牛。Objective To analyze the reasons of cardiac permanent pacemaker replacement and the strategies to prevent relevant complicationsnethods The clinical data of 57 patients, 38 males and 19 females, aged 74±8 （56-94）, 31 with sick sinus syndrome, 26 with Ⅱ or Ⅲ degree atrioventricular block, who underwent 63 times of cardiac permanent pacemaker replacement, including 13 times of lead replacement, were analyzed. Results The reason of replacement included battery normal exhaustion for 57 case-times,battery exhaustion before the defined schedule for 2 case-times, lead electrodes incompletely fractured for 2 case-times, and infection of pacemaker pocket for 2 case-times. There were 9 cases of placement-related complications： pacemaker pocket hematoma （ n = 4）, lead dislocation （ n = 3 ） , and abandoned leads falling into the right ventricle （ n = 2）. The average lifetime of old pacemakers was 9. 25 years （2 -15 years）. The pacing threshold of ventricular leads after pacemaker replacement was （0. 77 ± 0. 40）V, significantly higher than the initial pacing threshold [ （0. 60 ±0. 21 ）V,P 〈0. 01 ]. There were no significant differences in the lead impedance and R wave amplitude between the pacemaker replacement and initial implantation [ （854 ±136） Ω vs （828 ±176） Ω, and（ 12 ±4） mV vs（ 12 ±4） mV, both P 〉0. 05 ]. Conclusion The main reason of pacemaker replacement is battery exhaustion. Most implanted ventricular leads still can be used. A rare serious complication of cardiac pacemaker replacement operation is abandoned lead falling into the right ventricle, and correct disposing of initial leads help avoid this complication .

关 键 词：心脏起搏器 人工 更换 

分 类 号：R686[医药卫生—骨科学]