小儿植入心外膜永久起搏器术后22例随访分析  

Follow-up analysis of the permanent epicardial pacemaker implantation in 22 children

作　　者：廖新息 胡桂梅 陈淑倩 

机构地区：[1]广州市妇女儿童医疗中心心血管科,广州510623

出　　处：《岭南心血管病杂志》2016年第5期573-576,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨小儿植入心外膜永久起搏器的治疗效果、并发症及心功能状况。方法对22例儿童植入心外膜永久起搏器。其中男10例,女12例,手术年龄8.5个月(3 d^11岁),体质量6.35(2.7~43.6)kg。因先天性心脏病术后Ⅲ°房室传导阻滞而植入起搏器18例,先天性完全性房室传导阻滞2例,阿斯综合征和病态窦房结综合征各1例。随访3个月~5年3个月,收集患者检查结果及心室夺获阈值、电极阻抗等电生理学信息。结果除1例植入双腔起搏器外,其余均植入单腔起搏器。与心动过缓有关的临床症状消失,患儿发育良好,起搏和感知功能良好。有2例(9.1%)患儿死亡(原因不明),3例(13.6%)出现电池提前耗竭而重新植入起搏器,未出现电极断裂、移位及囊袋感染等并发症。末次复查超声心动图左心室射血分数为66%±6%,有1例(4.8%)患者出现心功能不全,左心室射血分数为51%,没有因心力衰竭入院的患者。将末次复查心室夺获阈值、电极阻抗、灵敏度与植入起搏器即刻进行比较,未发现显著变化。结论心外膜起搏近、中期治疗效果令人满意。本组出现因安装单腔起搏器导致心功能不全的患者,需进一步优化起搏器选择策略。Objectives To explore the effect, complications and cardiac function in children after permanent epicardial pacemaker implantation. Methods Totally 22 infants and children were implanted permanent epicardial pacemaker. Among them, 10 were male and 12 were female. Mean age at operation was 8.5 months （ranging from 3 days to 11 years old）, and mean weight at operation was 6.35 kg （ranging from 2.7 to 43.6 kg）. Of them, 18 cases were implanted permanent epicardial pacemaker with atrioventricular block （AVB） for cardiac surgery, 2 cases for congenital complete atrioventricular block （CCAVB） and 2 cases for Adams-Stokes syndrome and sick sinus syndrome respectively. The follow-up was 3 months to 5 years and 3 months.We had the patients review electrocardiogram,X-ray and echocardiogram examination. The examination results and ventricular capture threshold,impedance and electrophysiological information were collected. Results There was 1 patient receiving dual-chamber pacemaker and the rest patients received single-chamber pacemaker. The clinical symptoms associated with bradycardia disappeared, children developed well, the pacing function and perceptual function of pacemaker were good. Two cases （9.1%） died with unknown reason, 3 cases （13.6%） were implanted pacemaker again because of pacemaker＇s battery depletion. No patients showed electrode breakage, electrode displacement, pacemaker sac infection or other complications. The latest reviewed echocardiography showed the mean ejection fraction was 66% ±6%. There was 1 case （4.8%） with cardiac insufficiency and the ejection fraction was 51%. No one was hospitalized due to heart failure. Compared with immediate pacemaker implantation, no significant increases were observed in the ventricular capture threshold, impedance and sensitivity in the latest follow-up examination. Conclusions The effects of permanent epicardial pacemaker for short-term and medium-term are satisfactory. This group shows that implantation of single-chamber pacemaker c

关 键 词：心外膜永久起搏器 随访 小儿 

分 类 号：R541.1[医药卫生—心血管疾病]