高频电刀应用对心血管植入型电子器械囊袋血肿发生率的影响  

Influence of high frequency electrosurgical equipment application in cardiac implantable electronic device implantation procedure on the rate of pocket hematoma

作　　者：徐白鸽[1] 梁延春[1] 高阳[1] 焉晓蕾 于海波[1] 刘荣[1] 许国卿[1] 王娜[1] 王祖禄[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《中国介入心脏病学杂志》2016年第9期502-505,共4页Chinese Journal of Interventional Cardiology

基　　金：辽宁省自然科学基金项目(2015020406)

摘　　要：目的探讨心血管植入型电子器械(CIED)植入术中应用高频电刀能否降低CIED囊袋血肿的发生率。方法回顾性分析在沈阳军区总医院接受新植入或更换CIED的患者3884例。CIED植入术中应用高频电刀的患者归为电刀组(3115例),而未应用高频电刀的患者归为对照组(769例)。两组患者各自又分为出血倾向亚组和无出血倾向亚组;出血倾向亚组再分为肝素桥接组和直接手术组。统计各组患者CIED囊袋血肿发生率。结果电刀组与对照组患者的基线资料均衡。CIED植入后1周共发生囊袋血肿86例(2.2%,86/3884),未发生CIED囊袋感染;而远期囊袋感染或破裂患者9例(10.5%,9/86)。电刀组囊袋血肿发生率显著低于对照组[1.5%(46/3115)比5.2%(40/769),P<0.001];电刀组中出血倾向亚组[1.8%(4/218)比11.5%(6/52),P=0.004]、无出血倾向亚组[1.4%(42/2897)比4.7%(34/717),P<0.001]和出血倾向亚组中的肝素桥接组[2.0%(2/100)比11.5%(6/52),P=0.020]CIED囊袋血肿发生率分别较对照组相应各亚组显著降低,差异均有统计学意义。对照组中出血倾向亚组CIED囊袋血肿发生率[11.5%(6/52)比4.7%(34/717),P=0.046]高于无出血倾向亚组,差异有统计学意义。而电刀组中出血倾向亚组与无出血倾向亚组的CIED囊袋血肿发生率比较,差异无统计学意义(P=0.560);电刀组出血倾向亚组中的肝素桥接组与直接手术亚组的CIED囊袋血肿发生率比较,差异亦无统计学意义(P=1.000)。结论CIED植入术中应用高频电刀能降低囊袋血肿的发生率,并降低口服抗凝或抗血小板药物对囊袋血肿发生率的影响。Objective To investigate the influence of high frequency electrosurgical equipment （ HFEE） application in cardiac implantable electronic device （ CIED） implantation procedure on the rate of pocket hematoma .Methods Patients who received CIED implantation in General Hospital of Shenyang Military Region were analyzed retrospectively .HFEE was applied during CIED implantation procedure in every patient who was classified into HFEE group .Other patients without HFEE application were classified as the control group . Patients with or without bleeding tendency were sub-classified into the bleeding tendency subgroup or non-bleeding tendency subgroup respectively .Bleeding tendency subgroup was further divided into heparin bridging group and direct implantation group .The occurance rate of CIED pocket hematoma was recorded in all groups .Results A total of 3884 patients were enrolled .There were 3115 patients in the HFEE group and 769 patients in the control group .The baseline data of two groups was similar.The overall rate of CIED pocket hematoma in the total patient population during perioperative period were 2.2%（86/3884）, and the rate of long term pocket infection or rupture in patients with CIED pocket hematoma was 10.5%（9/8）.In the HFEE group, the rate of pocket hematoma was lower than that in the control group （1.5%vs.5.2%, P〈0.001）.The rates of CIED pocket hematoma in respective subgroups in the HFEE group including the bleeding tendency subgroup （ 1.8% vs.11.5%, P=0.004 ） , the non-bleeding tendency subgroup （ 1.4% vs.4.7%, P〈0.001 ） and the heparin bridging group （ 2.0% vs. 11.5%, P=0.046 ） were markedly decreased as compared with the corresponding subgroups in the control group.In the control group , the rate of CIED pocket hematoma in the bleeding tendency subgroup was higher than that in the non-bleeding tendency subgroup （11.5%vs.4.7%, P=0.0046）.In HFEE group, there was no significant difference in the rate of CIED pocket hematoma between bleeding tendency subgroup a

关 键 词：心血管植入型电子器械 高频电刀 囊袋 血肿 

分 类 号：R541.7[医药卫生—心血管疾病]