经静脉途径拔除导线的临床分析  

Retrospective analysis of the transvenous lead extraction

作　　者：白慧[1] 任晓庆[1] 马坚[1] 王京[2] 王方正[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037 [2]北京武警总医院心内科

出　　处：《中华心律失常学杂志》2015年第4期254-256,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的心血管植入型电子器械（CIED）导线经静脉途径拔除的安全性和有效性.探讨不同类型导线拔除的成功率.方法选择2004年1月至2014年12月在中国医学科学院阜外医院行经静脉途径拔除导线的患者215例（共计406根导线）,回顾性分析导线拔除适应证、拔除工具和方式,拔除导线类型、成功率和并发症.结果共215例患者（共计406根导线）纳入该研究.其中感染174例,导线故障37例,有症状的上腔静脉阻塞综合征4例.拔除右心房电极导线167根,右心室电极导线187根,左心室电极导线19根,除颤电极导线26根.导线拔除总成功率为98.3％（399/406）,其中导线完全拔除346根（完全成功率85.2％,346/406）;失败3例,共7根导线（失败率1.7％,7/406）.比较直接牵拉、锁定钢丝和机械性扩张鞘拔除右心房、右心室和除颤电极导线的成功率,成功率差异无统计学意义（P＞0.05）.2例发生严重并发症,1例为心脏压塞,另1例为三尖瓣大量反流.结论经静脉途径拔除导线安全有效.Objective To evaluate the effectiveness and safety of the transvenous lead extraction using a standard stepwise approach.Methods We retrospectively identified cases of transvenous lead extractions by simple traction or with the use of non-powered extraction tools in our hospital between Jan 2004 and Dec 2014.The indications for lead extraction,different extraction tools and approaches used in the extraction procedures,success rate and complications were analyzed.Results Lead extraction was attempted in 406 leads from 215 patients.The indications for lead removal included device infection（n=174）,lead dysfunction（n=37）and symptomatic central venous obstruction （n =4）.One hundred and sixty seven leads in atrial,187 leads in right ventricle,19 leads in left ventricle and 26 implantable cardioverter defibrillater leads were extracted respectively.The total success rate of lead extraction was 98.3%.The complete procedural success rate was 85.2%（346/406）.Seven leads in 3 patients had not been extracted.The failure rate was 1.7%（7/406）.The success rate of lead extraction had no statistically significance difference among atrial leads、ventricular leads and implantable cardioverter defibrillator leads using simple traction,locking stylets or dilator sheaths （P〉0.05）.Major complications included pericardial tamponade（1 case）and tricuspid valve insufficency（1 case）.Conclusion Transvenous lead extraction is safe and efficiency.

关 键 词：心血管植入型电子器械 导线拔除术 感染 

分 类 号：R654.2[医药卫生—外科学]