20例埋藏式心脏复律除颤器安置技术总结  

Implantation techniques of 20 implantable cardioverter defibrillators

作　　者：任自文[1,2,3,4,5,6,7] 宋有城[1,2,3,4,5,6,7] 胡大一[1,2,3,4,5,6,7] 张金荣 马虹 葛堪忆[1,2,3,4,5,6,7] 杜雪平 朱俊[1,2,3,4,5,6,7] 丁燕生 杨新春[1,2,3,4,5,6,7] 商丽华 王青[1,2,3,4,5,6,7] 郭静萱[1,2,3,4,5,6,7] 

机构地区：[1]北京医科大学第一医院 [2]中国医学科学院中国协和医科大学阜外心血管病医院 [3]北京红十字朝阳医院 [4]北京安贞医院 [5]中山医科大学附属第一医院 [6]北京医科大学第三医院 [7]北京复兴医院

出　　处：《中华心血管病杂志》1998年第6期458-461,共4页Chinese Journal of Cardiology

摘　　要：目的总结２０例埋藏式心脏复律除颤器（ＩＣＤ）的安置经验。方法总结分析２０例患者的一般临床情况、手术技巧、心室颤动（室颤）的诱发及除颤阈值（ＤＦＴ）测定方法以及ＩＣＤ的程控原则。结果２０例患者中男１８例，女２例；平均年龄５４．１±１４．４岁；冠心病１１例，扩张型心肌病２例，房缺修补术后１例，右室发育不良２例，原发性室颤１例，无器质性心脏病者３例；１９例术前均接受胺碘酮治疗，１例服用索他洛尔。手术全部采用单切口，ＩＣＤ埋于胸大肌下，电极导线于切口内经锁骨下静脉穿刺送入右心室。首选Ｔ波同步电击法诱发室颤，成功率８０％。ＤＦＴ１８．４±４．７Ｊ，１例对调电击极性、１例加用上腔静脉电极后ＤＦＴ才符合要求。电击阻抗５３．７±７．６Ω。Ｒ波振幅１２．４±６．０ｍＶ，１例因Ｒ波振幅低而加用心室螺旋电极。起搏阈值０．６±０．２Ｖ。起搏阻抗５４０．０±１１０．８Ω。１例与单极起搏器合用，术中测试无相互影响。结论胸部单切口置入ＩＣＤ方法简便可靠，术中需酌情决定上腔静脉电极及心室螺旋电极的使用，Ｔ波同步电击是一种安全有效的诱发室颤方法。ＩＣＤ与起搏器合用时。Objective To summarize the experience of implantation of imptanlable cardioverter defibrillator (ICD) in 20 patients. Methods The general clinical status, skills of procedures, the methods of inducing ventricular fibrillation (Vf) and measuring defibrillation threshold (DFT), and the principles of programming ICD were analyzed in 20 cases. Results Eighteen males, two females; the average age was 54.1±14.4 years old; eleven patients with coronary heart disease, two with dilated cardiomyopathy, one with repaired atrial septal defect, two with right ventricular desplasia, one with primary Vf, three without organic heart diseases. Nineteen patients took amiodarone and one took sotalol before procedures. Single chest incision procedures were performed in all cases, ICDs were implanted under pectoralis major and the electrode leads were introduced to the apexes of right ventricles by puncturing subclavicular veins. T wave synchronous shock were used to induce Vf at first in all cases and success rate was 80%. DFT 18.4±4.7J.DFT was qualified after reversing polarity in one case and by using SVC lead in another case. Shock path impedance was 53.7±7.6 ohms. R wave was 12.4± 6.0 mV, A screw in electrode lead was added in right ventricle in one case because R wave was lower. Pacing threshold was 0.6±0.2V. Pacing impedance was 540.0±110.8 ohms. Combined use of ICD and unipolar pacemker in one case, measures revealed no interaction between them during the operation. Conclusions Single chest incision procedure of implanting ICD was simple and reliable. Whether use of screw in electrode lead and SVC lead should be determined during operation according to the R wave amplitude and DFT.T wave synchronous shock is an effective and safety method of inducing Vf. The interaction of each other should be observed and measured during operation if using combined ICD and unipolar pacemaker.

关 键 词：除颤器置入术 心动过速 心室颤动 

分 类 号：R654.2[医药卫生—外科学] R541.705[医药卫生—临床医学]