心外膜永久起搏器在儿童及婴幼儿中的应用  

Feasibility and safety of epicardial pacemaker implantation in infants and children

作　　者：张文波[1] 叶明[1] 陈纲[1] 仇万山[1] 闫宪刚[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心胸外科,上海201102

出　　处：《中华小儿外科杂志》2015年第8期608-610,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的总结心外膜永久起搏器在儿童及婴幼儿中的应用，评估其可行性及安全性。方法复旦大学附属儿科医院2005年7月至2014年6月对18例高度房室传导阻滞的儿童及婴幼儿植入心外膜永久起搏器，其中男11例，女7例；年龄最小4个月，最大7岁；平均体质量（13．3±5．8）kg；11例为先天性心脏病手术后引起的房室传导阻滞，其余7例植入前未行心脏手术。回顾性分析该组病例的数据资料，分析心外膜永久起搏器的外科手术植入情况、术后随访患儿病情、并发症发生情况以及起搏参数变化。结果18例患儿中有15例植入单腔起搏器，3例植入双腔起搏器，共植入21根电极。植入途径均采用经胸部正中切口路径，电极连接至右心室或右心房，手术均顺利完成。脉冲发生器置于患儿左侧腹部皮下，心外膜电极做充分的预留长度，以适应小儿的生长发育。术后平均随访32．2个月，所有18例患儿无死亡病例，1例发生电极断裂，1例手术伤口感染发生；起搏阈值、感知参数及电极阻抗均正常。结论由于心脏畸形，年龄及生长发育的关系，心外膜起搏器是儿童及婴幼儿永久起搏治疗的首选。我们的研究表明植入心外膜电极是可行且安全的，且操作简单，并发症少。Objective To evaluate the feasibility and safety of permanent epicardial pacing in infants and children. Methods From July 2005 to June 2014, the clinical data were collected and analyzed for 18 children undergoing permanent epicardial pacemaker implantation at our cardiovascular center. There were 11 boys and 7 girls with an age range of 4 months to 7 years and a mean weight of 13.3 ± 5.8 kg. And 11 cases were diagnosed as atrium-ventricle block （AVB） after operations for congenital heart disease （CHD） while another 7 cases had no heart surgery. And their operative records and parametric changes during implantation were retrospectively analyzed. Results Among them, VVI （single chamber, n = 15） and DDD （dual chamber, n = 3） permanent epicardial pacing leads were implanted. Implantation was completed via midline thoracotomy and all surgical epicardial electrode leads were successfully implanted on right atrium and right ventricle. Pulse generators were placed in abdominal wall in a subcutaneous or submuscular pocket and pacing leads prepared for individual growth. No mortality occurred during an average follow-up period of 32. 2 months. There were only lead fracture （n = 1） and wound infection （n=1）. Impedance, sensing and stimulation thresholds were all in normal ranges. Conclusions As a first-choice procedure for infants and children with severe AV conduction block, epicardial pacemaker is both safe and efficacious with fewer complications.

关 键 词：心外膜 心脏起搏器 人工 婴儿 儿童 

分 类 号：R725.4[医药卫生—儿科]