永久型起搏器更换时心室电极参数的临床分析  

Clinical Investigation of the Lead Parameters on Implanted Ventricular Leads in the Patients with Cardiac Pacemakers Replacement

作　　者：伍旭升 金松元 张祖茂 曹建敏 

机构地区：[1]上海市第五人民医院心内科,上海200240

出　　处：《中国临床医学》2001年第3期251-252,共2页Chinese Journal of Clinical Medicine

摘　　要：目的 :分析永久型人工心脏起搏器更换时心室电极参数的变化。方法 :更换永久型起搏器 3 2例 (男 19例 ,女 13例 ) ,年龄 64.7± 14 .8( 3 5～ 87)岁 ,病窦综合征 2 2例 ,Ⅲ度房室传导阻滞 10例。在更换过程中 ,应用临时起搏器及起搏分析仪直接测量原心室电极参数。结果 :至测量时原心室起搏电极在体内埋置时间为 96.4± 2 2 .6( 2 5～ 186)个月 ,首次埋置时的起搏阈值为 0 .5 8± 0 .2 6V ,更换起搏器时为 1.5 9± 0 .74V(P <0 .0 0 1) ,起搏阈值增加幅度为 196.2 %± 13 8.3 % ( 2 0 %～ 5 64% ) ,增加的绝对值为 1.1± 0 .6( 0 .3～ 3 .0 )V ,更换起搏器起时 ,原心室电极阻抗为 65 8.7± 14 3 .2Ω ,R波振幅为 2 .8± 0 .9mV。更换起搏器后 ,继续使用原心室电极 2 3例 ,术后随访 63 .7± 4 1.4 ( 6～ 15 6)个月。 3例因更换时测出原心室电极起搏阈值或阻抗增高 ,重新安置新电极 ,2例因伤口感染不愈而在对侧安置新电极 ,2例因微脱位、另 2例因改换其它公司起搏器而重新安置新电极 ,其余病人均起搏与感知功能良好。结论 :埋植式心室起搏电极使用约 10年后大多数电极参数的直接测量数据仍在良好范围内 ,可以继续使用 ,但必须随访 。Objective: To investigate the changes of the lead parameters measuremen ts on implanted ventricular leads in the patients with cardiac pacemakers replac ement. Methods: 32 cardiac pacemakers were replacemented, 19 male and 1 3 female, mean age 64.7±14.8 years. 22 patients were sick sinus syndrome and 10 patients were third degree atrioventricular block. T he direct lead parameters of implanted ventricular leads were measured in replacement. Results: The ventricular leads had bee n implanted for 96.4±22.6(25～186)months during pulse generator replacement. R esults showed the chronic pacing threshold of leads during pulse generator repla cement were higher than initial pacing threshold ( 1.59±0.74V vs 0.58±0.26V P<0.001 ). Chronic pacing threshold of leads during pulse generator replace ment were increased by 19.6%±138.3%(20%～564%), with mean increased value of 1.1± 0.6(0.3～3.0)V, R wave amplitude 2.8±0.9mV. Chronic lead impedances were 658. 7 ±143.2Ω during pulse generator replacement. Postoperatively, 23 old leads were continued to perform the pacing function and were followed up for 63.7±41.4(6 ～156)months. 3 cases were implanted new ventricular leads because of the chron i c pacing throshold or impedances were increased during pulse generator replaceme nt, 2 cases were implanted new ventricular leads in the lateral place beca use of infections, 2 cases because of partly dislocation and 2 cases because of implanted the other company's pacemakers were implanted new ventricular leads d uring pulse generator replacement. The remainders paced with good sensitivity .Conclusion: Most direct lead parameters on implanted ventricular leads for near 10 years are within normal ranges. Pacemakers continue to perform pacing function. Follow up should be taken regularly for those patients.

关 键 词：心脏起搏 心室电极 电极参数测量 永久型起搏器 

分 类 号：R654.2[医药卫生—外科学]