小儿永久性起搏器植入术7例  

Clinical analysis of 7 children with permanent cardiac pacemaker implantation

作　　者：周凯[1] 秦玉明[1] 曹黎明[1] 杨世伟[1] 赵乃铮[1] 王凤鸣[1] 钱建华[1] 龚晓平[1] 

机构地区：[1]南京医科大学附属南京儿童医院心脏内科,210008

出　　处：《中华实用儿科临床杂志》2015年第7期529-531,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨小儿安装右心室心尖部心内膜单腔永久性起搏器的临床效果.方法 收集2007年6月至2012年10月经静脉安装右心室心尖部心内膜单腔永久性起搏器的7例患儿的临床资料.男5例,女2例;年龄2岁10个月-12岁10个月;体质量12.5 -52.5 kg.基础病因为病毒性心肌炎3例,先天性Ⅲ度房室传导阻滞2例,室间隔缺损外科修补术后2例.心电图示心室率38 -72（46.5±7.6）次/min.选择右心室心尖部心内膜单腔永久性起搏,起搏导线置入路径经锁骨下静脉.术后1、3、6个月及每0.5年参与临床随访,行心电图、胸片、超声心动图检查,并对起搏参数进行检测.结果 起搏器电极导线均为双极起搏电极;起搏器类型为频率适应性心室起搏（VVIR）5例,频率固定心室起搏（ⅤⅥ）2例;起搏器囊袋置于胸大肌下6例,皮下1例;1例术后2周出现囊袋感染,1例术后6年更换起搏器,并由单腔起搏模式变为双腔起搏模式.7例患儿随访1 -7年,心电图示起搏功能良好,心脏超声示心脏大小及功能保持在正常范围,未发现心功能不全及死亡病例.结论 小儿右心室心尖部心内膜单腔永久性起搏安全、有效,应注意常规随访.Objective To investigate the clinical effects of pediatric patients after implantation of pernanent single chamber right ventricle apex endocardial pacemakers.Methods Seven cases were implanted with permanent pacemakers from June 2007 to October 2012 and transvenous endocardial insertion was performed in all the patients.Five of them were boys,and 2 cases were girls.The ages ranged from 2 years and 3 months to 13 years and 10 months.The weight ranged from 12.5 kg to 52.5 kg.Three cases of them were viral myocarditis.Two cases were congenital Ⅱ-degree atrioventricular block.Two cases were acquired atrioventricular block after cardiac surgery for correction of ventricular septal defect.The ventricular rate on electrocardiogram was 38-72（46.5 ±-7.6） beats per minute.The pacing lead was implanted into right ventricle through subclavian.The patients were followed up for 1,3,and 6 months after implantation,and then every 6 months or as needed.Electrocardiogram,X-ray,echocardiogram examination,and parameters of pacemaker should be noticed and follow-up study should be conducted.Results Pacemaker electrode leads were all bipolar pacing electrode.Ventricular pacing,ventricular sensing,inhibition response and rate adaptive （ⅤⅥR） mode devices were in 5 patients.Ventricular pacing,ventricular sensing and inhibition response （ⅤⅥ） mode devices were in 2 patients.Six pacemakers were implanted into ectopectoralis and 1 pacemaker was implanted into subcutaneous tissue.Pacemakers sac infections presented in 1 case after 2 weeks postoperatively.Single chamber pacing was replaced by dual chamber pacing in 1 case after 6 years postoperatively.The follow-up period was from 1 year to 7 years.Cardiac chamber sizes and cardiac functions for 7 patients maintained normal during follow-up.Pacing status and sensitivity were satisfactory for all these patients during follow-up.Heart failure was not found and none of them died.Conclusions Permanent single chamber right ventricle apex endocardial pacing anong the pediatri

关 键 词：永久性起搏器 右心室 心尖部 心内膜 儿童 

分 类 号：R725.4[医药卫生—儿科]