新型冠状病毒肺炎防控期间心血管植入型电子器械更换患者的临床管理策略分析  

Analysis of clinical management strategy in patients treated with cardiovascular implantable electronic device replacement during the COVID-19 pandemic

作　　者：蔡迟[1] 牛红霞[1] 华伟[1] 任晓庆[1] 申玉静[1] 张竞涛[1] 侯翠红[1] 唐闽 张澍[1] Cai Chi;Niu Hongxia;Hua Wei;Ren Xiaoqing;Shen Yujing;Zhang Jingtao;Hou Cuihong;Tang Min;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Diseases,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

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

出　　处：《中华心律失常学杂志》2020年第3期283-287,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的:分析新型冠状病毒肺炎(COVID-19)疫情防控期间心血管植入型电子器械(CIED)更换患者的临床资料,探讨特殊时期该类患者的管理策略。方法:回顾性收集中国医学科学院阜外医院心律失常中心2020年2月10日至4月10日COVID-19疫情期间接受起搏器及除颤器更换患者的临床资料,与2019年同期更换患者的临床资料进行分析与比较。结果:研究共纳入13例患者,年龄(68.2±7.8)岁,男5例(38.5%),11例(84.6%)患者来自北京地区。5例(38.5%)患者合并黑矇/晕厥史且为起搏依赖,8例(61.5%)患者达到择期更换适应证(ERI)或耗竭期(EOL),未达到ERI或EOL者CIED电池剩余时间(2.3±1.0)个月。3例起搏依赖患者达到ERI。12例(92.3%)患者进行了单腔心室起搏器(VVI)或双腔起搏器(DDD)更换,1例(7.7%)患者进行了植入型心律转复除颤器(ICD)更换。与2019年同期相比,CIED更换数量明显下降,更多患者来自北京地区,合并黑矇或晕厥史、起搏依赖、ERI或EOL比例[15(38.5%)对8(61.5%), P=0.201]更高以及CIED电池电量剩余时间[(5.5±3.5)月对(2.3±1.0)月, P=0.001]更短。 结论:在COVID-19疫情防控期间,应针对性筛选需紧急行器械更换患者,对合并黑矇或晕厥史、起搏依赖以及达到ERI/EOL的患者,特别是已达到ERI/EOL的起搏依赖患者,应优先进行CIED更换以最大化保证患者安全。Objective To analyse baseline clinical characteristics and investigate management strategy in patients treated with cardiovascular implantable electronic device(CIED)replacement during the COVID-19 pandemic.Methods The study included 13 consecutive patients who underwent CIED replacement at Fuwai hospital during the COVID-19 pandemic,and the baseline clinical characteristics were compared to the patients with CIED replacement in the corresponding periods of 2019.Results The mean age of study patients cohort was(68.2±7.8)years and 5 patients(38.5%)were male,11 patients(84.6%)came from Beijing.Five patients(38.5%)presented pre-syncope/syncope and pacemaker-dependent.Eight patients(61.5%)were at elective replacement indicator(ERI)or at device end of life(EOL),and the other 5 patients(38.5%)without ERI/EOL presented with(2.3±1.0)months of battery remaining.Three patients with pacemaker-dependent were at ERI.Twelve patients(92.3%)underwent VVI/DDD pacemaker replacement and only 1 patients(7.7%)underwent ICD generator replacement.Compared to the patients in the corresponding periods of 2019,the procedure amount of CIED replacement dramatically declined and more patients came from Beijing,and the proportion of pre-syncope/syncope and pacemaker-dependent as well as ERI/EOL[15(38.5%)对8(61.5%),P=0.201]and minimal battery remaining[(5.5±3.5)months vs.(2.3±1.0)months,P=0.001]was higher.Conclusion Patients who presented pre-syncope/syncope and pacemaker-dependent as well as ERI/EOL and minimal battery remaining should be considered preferentially to underwent urgent or emergent CIED replacement procedures to keep patients safe during the COVID-19 pandemic.

关 键 词：心脏起搏 人工 新型冠状病毒肺炎 更换 电池耗竭 起搏依赖 

分 类 号：R197.323[医药卫生—卫生事业管理] R541.7[医药卫生—公共卫生与预防医学]