埋藏式心脏除颤器患者频繁电击原因分析及对策  

The Cause Analysis and Countermeasures of Frequent Shocks in Patients with Implantable Cardioverter Defibrillator

作　　者：吴冬燕[1] 邢彩耐[1] 卢凤民[1] 付乃宽[1] 许静[1] 

机构地区：[1]天津市胸科医院,300222

出　　处：《天津医药》2014年第3期260-263,共4页Tianjin Medical Journal

摘　　要：目的：探讨植入埋藏式心脏除颤器（ICD）的患者出现频繁放电的原因及处理方法。方法随访80例因心力衰竭或恶性室性心律失常植入ICD的患者，男62例，女18例，其中单腔ICD 35例，双腔ICD 23例，三腔ICD （CRTD）22例，随访1~6年，了解ICD的放电原因，并根据具体情况进行治疗。结果80例患者中有23例患者遭受电击，其中10例为频繁电击（24 h内电击≥3次或1年内电击≥5次），均为心脏猝死二级预防患者。频繁电击的原因包括：室速反复发作，除颤阈值升高电击无效，对频繁发作的短阵室速或室上性心律失常的误识别。处理方法：调整室速与室上速鉴别流程，增加室速判定心搏数目及充分利用ICD的起搏功能；联合使用抗心律失常药物，尤其是美托洛尔和（或）胺碘酮。经ICD参数优化和抗心律失常药物治疗后电击明显减少。结论抗心律失常药物的合理应用和有效ICD程控可在保障患者安全的同时明显减少ICD电击。Objective To investigate the cause and countermeasures of frequent shocks in patients with implantable cardioverter defibrillators （ICD）. Methods Eighty ICD patients with heart failure and malignant ventricular arrhythmias were followed up, including sixty-two male and eighteen female patients. There were 35 patients with single-chamber ICD, 23 with dual-chamber ICD and 22 with three-chamber ICD. Patients in this study were followed up for 1-6 years to analyze the reasons for ICD discharge. According to the specific circumstances, patients were treated. Results Twenty-three pa-tients in 80 patients suffered from shock treatment. Ten patients （12.5%） experienced frequent shocks. The causes of fre-quent shock included repeated episodes of ventricular tachycardia, invalid shock due to increased defibrillation threshold （DF） and false identification of the frequent episodes of paroxysmal ventricular tachycardia or arrhythmias. The management included the identification process adjustment of ventricular tachycardia and supraventricular tachycardia, increased num-bers of beats of ventricular tachycardia judgment and increase the basic pacing rate. The anti-arrhythmic drugs should be combinedly used, especially metoprolol and amiodarone. The ICD shock was significantly reduced after parameter optimiza-tion and anti-arrhythmic therapy. Conclusion The ICD shocks were effectively reduced with rational use of anti-arrhyth-mic drugs and valid ICD programming.

关 键 词：心血管疾病 除颤器 植入型 心律失常 心性 猝死 电休克 埋藏式心脏转复除颤器 频繁电击 二级预防 电休克治疗 

分 类 号：R541[医药卫生—心血管疾病] R454.1[医药卫生—内科学]