80岁及以上患者起搏器治疗的特殊性分析  

Special considerations for patients aged 80 years or over receiving pacemaker implantation

作　　者：韩战营[1] 郑绪伟[1] 邱春光[1] 陈晓杰[1] 卢文杰[1] 

机构地区：[1]郑州大学第一附属医院心内科,450052

出　　处：《中华老年医学杂志》2014年第7期748-750,共3页Chinese Journal of Geriatrics

摘　　要：目的 探讨80岁及以上患者起搏器植入适应证、起搏方式、起搏参数及术后并发症.方法 连续选取行起搏器治疗的高龄老年患者112例（80～94岁组）,普通老年患者484例（60～79岁组）,随访观察两组患者植入起搏器适应证、起搏方式、起搏参数及术后并发症的特点. 结果 80～94岁组冠心病58例（51.8％）,与60～79岁组163例（33.7％）比较,差异有统计学意义（x2=12.78,P＜0.01）;80～94岁组单腔起搏器植入患者为63例（56.3％）,双腔或多腔起搏器49例（43.8％）,与60～79岁组217例（44.8％）、267例（55.2％）比较,差异有统计学意义（x2分别为4.76、4.76,均P＜0.05）;因双束支传导阻滞植入起搏器患者19例（17.0％）,高于60～79岁组31例（6.4％）,差异有统计学意义（x2 =13.20,P＜0.01）;术后急性脑梗死并发症发生率均高于60～79岁组（P＜0.01）;80～94岁组心室起搏阈值、心房起搏阈值（0.78±0.24）V、（1.07±0.22）V,较60～79岁组（0.55±0.16）V、（0.84±0.28）V增高（均P＜0.05）. 结论 应正确认识高龄老年患者起搏器治疗的特殊性,在全面评估其临床状况的条件下合理地选择起搏治疗以取得最大的临床效果.Objective To investigate indications,pacing modes,pacing parameters and postoperative complications of pacemaker implantation for patients aged 80 years or over.Methods Patients were recruited on a continuous basis and were assigned into two groups,with 112 patients in the very elderly （80-90 years old） group and 484 patients in the elderly （60-79 years old） group,which served as the control.Follow-up observations with the two groups were conducted concerning indications,mode selection,pacing parameters and postoperative complications.Results Compared with the control group,the very elderly group showed：1） a higher rate of coronary heart disease （58cases vs.163 cases or 51.8％ vs.33.7％ ; x2 =12.78,P＜0.01） ; 2） more single-chamber pacemaker implantations （63 cases vs.217 cases or 56.3％ vs.44.8％; x2=4.76,P＜0.05） and fewer dual-or multi-chamber pacemaker implantations （49 cases vs.267 cases or 43.8％ vs.55.2％ ; x2 =4.76,P＜0.05） ; 3） a higher rate of double bundles branch block （19 cases vs.31 cases or 17.0％ vs.6.4％ ; x2=13.20,P＜0.01）; 4） a higher rate of postoperative acute cerebral infarction （x2 =8.34,P＜0.01） ; and 5） increased ventricular [（0.78±0.24）V vs.（0.55±0.16）V,P＜0.05]and atrial [（1.07±0.22）V vs.（0.84±0.28）V,P＜0.05]pacing thresholds.Conclusions Special considerations should be made when pacemaker implantation is planned for patients aged 80 or over.Pacemaker selection decisions ought to be based on a comprehensive evaluation of relevant clinical situations so that clinical benefits can be maximized.

关 键 词：老年人 80以上 心脏起搏器 人工 

分 类 号：R541.7[医药卫生—心血管疾病]