心脏再同步治疗中膈神经刺激的单中心回顾分析  

A single-center retrospective analysis of phrenic nerve stimulation in cardiac resynchronization therapy

作　　者：林永青[1] 王景峰[1] 陈样新[1] 袁沃亮[1] 陈明[1] 

机构地区：[1]中山大学附属第二医院心内科,广州510120

出　　处：《中华心律失常学杂志》2010年第3期176-178,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨心脏再同步治疗（CRT）植入术中、术后膈神经刺激发生隋况及处理方法。方法心力衰竭患者79例，其中男性45例，女性34例，年龄35～86岁，接受CRT／CRT—D植入术。术后平均随访24个月，观察膈神经刺激发生情况，同时给予相应的处理措施。结果78例患者成功植入，成功率为98．7％。植入术中、术后膈神经刺激发生率为12．8％。后静脉、侧后静脉是其好发部位，身材偏矮小及心脏增大的患者CRT植入中出现膈神经刺激危险性增高。调整电极导线位置、输出电压和脉宽以及改变极性等方法，可以有效消除膈神经刺激。结论膈神经刺激是CRT／CRT-D植入术中、术后的常见并发症；严格做好术中预防、术后随访，及时采取有效的干预手段，以减少或避免膈神经刺激的发生。Objective To analyze the phrenic nerve stimulation and the appropriate treatment during and after CRT/CRT-D implantation. Methods Seventy-nine patients （ 45 men and 34 women, aged 35 - 86 years） received CRT/CRT-D implantation. The patients were followed up for average 24 months. The phrenic nerve stimulations was analyzed and the corresponding treatments were taken. Results Seventy-eight patients received successful implantation（98.7% ）. The incidence rates of the phrenic nerve stimulation is 12. 8% during and after the implantation. Posterior veins and posterior lateral veins are predilection sites. The risk in- creased in the patients with short stature and enlarged heart. Phrenic nerve stumilation can be eliminated by ad- justing the electrode position, output voltage pulse, width and changing the polarity. Nobody needs another oper- ation because of the phrenic nerve stimulation. Conclusions Phrenic nerve stimulation is a common complication of CRT/CRT-D implantation operation. Doctors should take great attention to prevent this complication during the implanting procedure and follow-up.

关 键 词：心脏再同步治疗 膈神经刺激 心力衰竭 并发症 

分 类 号：R541.6[医药卫生—心血管疾病]