心脏起搏器更换187例的问题分析  

Reasons and complications of pacemaker replacement operation: clinical analysis of 187 cases

作　　者：陈杰[1] 闫庆凯[1] 傅春江[1] 张俊[1] 王旭开[1] 

机构地区：[1]第三军医大学第三附属医院野战外科研究所,重庆400042

出　　处：《中国心脏起搏与心电生理杂志》2015年第6期551-553,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨起搏器系统更换的原因及更换术并发症的防治。方法回顾分析187例行起搏器系统更换术患者的临床资料,通过定期门诊或电话随访了解患者并发症的发生情况。结果所有的患者均更换了脉冲发生器,其中首次更换171例,第2次更换15例,第3次更换1例。更换原因:电池提前耗竭19例(10.16%),电池使用寿命(6.43±2.48)年;166例达到预期寿命(88.77%),使用寿命约(8.52±2.11)年;有2例由于首次植入术后囊袋破溃感染提前更换(1.07%)。更换原电极27例,更换原因:术中测试起搏电极阈值增高5例,感知障碍4例,患者认为电极使用时间较长、要求与脉冲发生器同时更换18例,原电极共使用时间(10.03±2.29)年。所有起搏器更换时的电极阻抗、R波振幅[(650±164)Ω,(11.04±4.16)m V]与初次植入时[(672±153)Ω,(10.74±4.37)m V]比较均无显著差异(P>0.05)。结论起搏器更换的主要原因是脉冲发生器电池寿命正常耗竭,而更换时原电极大部分保留继续使用。严格规范的术前准备、术中操作以及术后管理,可降低起搏器更换术并发症的发生率。Objective To investigate the reasons of cardiac permanent pacemaker replacement and strategies to prevent relevant complications. Methods One hundred and eighty-seven patients who underwent pacemaker replacement operation in Daping hospital from January 2005 to December 2014 were included. Patients were conventionally received anout-patient follow-up, to understand the occurrence of complications. Results All patients were replaced pulse generator, 171 cases replaced firstly, 15 cases replaced secondly, and 1 case replaced thirdly. The causes of disused pulse generator： battery exhaustion before the defined schedule in 19 cases （10.16%）, the average service life of the battery was （6.43±2. 48） years;the expected life of battery in 166 cages （88.77%） was achieved,the average life was （8.52±2.11） years; 2 cases were due to pacemaker-pocket infection after the implantation （ 1.07% ）. There were 27cases replaced the electrodes. The causes of disused electrodes ： extra-high threshold in 5 cases, perceived barriers in 4 cases, patient＇s own request to replace the generation 18 cases. The average replaced-leads life was （10.03±2.29） years. There were no significant difference in the leads impedance and R wave amplitude between the pacemaker replacement and initial implantation [ （650±164）Ωvs （672±153）Ω,（11.04±4.16）mV vs （10.74±4.37）mV, both P〉0.05]. Conclusion The main causes of cardiac pacemaker replacement is life time of battery depletion normally, most of disused electrodes could retain. Pacemaker implantation is associated with a notable complication risk, and these complications could be significantly decreased with careful decision and appropriate treatment. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2015,29 （6） ：551-553]

关 键 词：心血管病学 心脏植入起搏器 更换 并发症 

分 类 号：R318.11[医药卫生—生物医学工程]