3D打印技术在心脏起搏器植入术中的应用  

Application of 3D printing technology in cardiac pacemaker implantation

作　　者：刘培健 孔婉文 吴坤生 康峰光 程小曲 LIU Pei-jian;KONG Wan-wen;WU Kun-sheng(Department of Cardiology,Guangzhou Medical University Shunde Hospital,Foshan 528300,China)

机构地区：[1]广州中医药大学顺德医院心内科,528300

出　　处：《中国实用医药》2018年第34期7-10,共4页China Practical Medicine

基　　金：佛山市医学类科技公关项目(项目编号:20161021030046)

摘　　要：目的探讨3D打印技术在心脏起搏器植入术中的临床应用价值。方法 44例具有心脏起搏器植入指征患者,随机分为3D打印组和对照组,各22例。两组患者均使用美敦力3830主动电极置入右心室中位间隔部, 3D打印组术前进行手术评估及模拟操作,对照组拟选取右心室中位间隔部为电极植入点。比较两组术中手术时间、X线暴露时间、术中出血量及术中和术后1、3个月QRS波时限、心室起搏的阈值、R波振幅、阻抗,并比较两组电极一次性置入率及术后并发症发生情况。结果 3D打印组患者手术时间、X线暴露时间分别为(57.85±15.38)、(32.00±10.13)min,均短于对照组的(66.52±9.93)、(42.99±10.48)min,差异有统计学意义(P<0.05)。两组患者术中出血量比较,差异无统计学意义(P>0.05)。两组术中和术后1、3个月QRS波时限比较,差异无统计学意义(P>0.05), 3D打印组术中、术后1、3个月QRS波时限短于对照组,差异有统计学意义(P<0.05)。3D打印组电极一次性置入率为95.5%,高于对照组的68.2%,差异有统计学意义(P<0.05)。两组术中和术后1、3个月心室起搏的阈值、R波振幅、阻抗比较,差异无统计学意义(P>0.05)。两组均成功置入电极,未发生急性心力衰竭、肺动脉栓塞、电极脱位及心肌穿孔等严重并发症。结论 3D打印技术应用于心脏起搏器植入术中,能提高3830电极置入的准确率及安全性,值得在临床推广。Objective To discuss the clinical value of 3D printing technology applied in cardiac pacemaker implantation. Methods A total of 44 patients with cardiac pacemaker implantation indication were randomly divided into 3D printing group and control group, with 22 cases in each group. All patients were implanted with the Medtronic 3830 active electrode in the right ventricular septum. 3D printing group received surgical evaluation and simulation before operation, and the control group chosen the median septum of the right ventricle as the electrode implantation site. Comparison were made on operation time, X-ray exposure time, intraoperative bleeding volume, QRS wave duration at 1 and 3 months after operation, threshold of ventricular pacing, R wave amplitude, impedance, one-time electrode implantation rate and complications between the two groups. Results 3D printing group had shorter operation time and X-ray exposure time respectively as(57.85±15.38) and(32.00±10.13) min than(66.52±9.93) and(42.99±10.48) min in the control group, and their difference was statistically significant(P<0.05). There was no statistically significant difference in intraoperative bleeding volume(P>0.05). There was no statistically significant difference in QRS wave duration during operation and at 1 and 3 months after operation between the two groups(P>0.05). 3D printing group had shorter QRS wave duration during operation and at 1 and 3 months after operation than the control group, and their difference was statistically significant(P<0.05). 3D printing group had higher one-time electrode implantation rate as 95.5% than 68.2% in the control group, and their difference was statistically significant(P<0.05). There was no statistically significant difference in threshold of ventricular pacing, R wave amplitude, impedance between the two groups(P>0.05). The electrodes were successfully placed in both groups, and no serious complications such as acute heart failure, pulmonary embolism, electrode dislocation and myocardial perforation occurre

关 键 词：3D打印技术 3830电极 安全性 准确率 应用 

分 类 号：R541.7[医药卫生—心血管疾病]