小儿永久心内膜起搏导线的可靠性研究  

Reliability of permanent endocardial pacing lead in children

作　　者：冯义柏[1] 黎明[1] 付文波[1] 毛奕[1] 朱慧[1] 

机构地区：[1]华中科技大学附属协和医院心内科,武汉430022

出　　处：《临床心血管病杂志》2012年第11期828-829,共2页Journal of Clinical Cardiology

摘　　要：目的:探讨小儿永久心内膜起搏导线的可靠性。方法:对8例先天性心脏病完全性房室传导阻滞患儿行永久心脏起搏治疗,采用常规的经锁骨下穿刺心内膜起搏方法,起搏模式除1例为单导线VDDR起搏外,其余均为VVI起搏。心内膜导线置入时在心腔内形成1个圆圈以应对患儿身体增长,早期2例仅为半圈。结果:1例于术后3个月猝死(原因不详);其余7例存活且追踪时间0.5～15.8年(平均5.5年)。追踪检查时,患儿身高、体重均已明显增长;起搏器功能稳定,起搏阈值及R波幅度均在正常变化范围之内;经胸超声检查心腔内沿起搏导线周围未见血栓形成,患儿无血栓形成的临床表现;胸部X线可见心腔内导线形状有一定变化,但圆圈仍存;1例VDDR出现间歇性心房感知不良,可能与导线形状改变有关,但起搏功能良好。结论:小儿永久起搏可采用常规的心内膜起搏方法,为应对小儿身体的增长使导线在心腔内保持1个圆圈,可以获得长期的稳定起搏。Objective：To explore the reliability of permanent endocardial pacing lead in children.Method：Eight children with congenital heart defects and complete atrioventricular block received permanent endocardial pacing（VVI in 7 and VDDR in 1）.The majority of the leads were unipolar（n=7）,tined,and steroid eluting.The leads were fixed to subcutaneous tissues in all patients and an atrial loop was created.Result：Except one patient suddenly died of unknown cause in 3 months after the implantation,the rest 7 children survived and were followed up for median 5.5 years（0.5-15.8 years）.Median endocardial ventricular pacing thresholds were stable and excellent（generally 0.59-0.90 V） for the whole period,and median R-sensing was satisfactory（12.2-12.6 mV）.Pacing impedances dropped after implantation and then remained stable.Clinically silent occlusion of the subclavian vein was not documented at follow-up by Echo-Doppler.Conclusion：Single-lead,permanent endocardial pacing by transcutaneous puncture of the subclavian vein and with atrial loop can have good efficiency and safety in children.Lead malfunction seems not to occur after the lead stretched with further somatic growth.

关 键 词：先天性心脏病 起搏器 小儿起搏 

分 类 号：R541.1[医药卫生—心血管疾病]