经静脉途径拔除植入心律起搏装置器械选择  

Equipment selection of extraction of cardiac implantable electronic device via intravenous route

作　　者：冯俊[1] 杨杰[2] 程自平[2] FENG Jun;YANG Jie;CHENG Ziping(Department of Cardiology,The Second People’s Hospital of Hefei,Hefei,230011,China;Department of Cardiology,The First Affiliated Hospital of Anhui Medical University)

机构地区：[1]合肥市第二人民医院心血管内科,合肥230011 [2]安徽医科大学第一附属医院心血管内科

出　　处：《临床心血管病杂志》2020年第7期658-661,共4页Journal of Clinical Cardiology

基　　金：合肥市卫健委和人社局重点资助项目(No:Hrs2017zd018)。

摘　　要：目的:探讨多器械联合运用在经静脉途径拔除植入心律起搏装置中的安全性和有效性。方法:回顾性分析和总结2017-08-2019-05就诊于我院,应用多器械、综合管理成功治愈植入心律起搏装置感染或导线断裂患者的临床资料。结果:11例植入心律起搏装置患者的18根导线(导线断裂1例、起搏器综合征1例、感染9例)经静脉途径成功拔除,其中3根导线徒手拔除,15根导线运用锁定钢丝和扩张鞘拔除。4例患者运用Evolution机械鞘拔除,1例经下腔静脉途径拔除,2例患者经囊袋清创,加强抗感染后好转;6例患者于对侧植入新的心律起搏装置,3例患者无植入新的起搏装置指征。所有患者未发生严重并发症。结论:植入心律起搏装置科学管理至关重要,严格无菌操作是预防感染相关并发症的关键。综合运用多种器械,个体化制定拔除策略安全高效。Objective:To investigate the safety and efficacy of multi-instrument combination in the removal of implanted pacemaker wires via vein.Method:The clinical data of patients,who were treated in our hospital from August 2017 to May 2019 and treated successfully with multiple instruments and comprehensive management for infection or wire rupture of implanted pacemaker devices,were retrospectively analyzed and summarized.Result:The 11 cases of patients with heart pacemaker implanted device 18 wire(wire breaking in 1 case,pacemaker syndrome in 1 case,9 cases of infection)through intravenous out success,of which three wire pulling with his hands,and 15 wire use locking wire and expanding sheath removal,4 cases of postoperative patients with mechanical sheath Evolution,1 case with inferior vena cava out way,2 patients by pouch debridement,enhance anti-infection after improvement.New pacemaker devices were implanted contralateral in 6 patients,and no indications of new pacemaker devices were implanted in 3 patients.No serious complications occurred in all patients.Conclusion:Scientific management of implanted pacemaker is very important.Strict aseptic operation is the key to prevent infection-related complications.Comprehensive use of a variety of instruments and individualized formulation of extraction strategy are safe and efficient.

关 键 词：植入心律起搏装置 导线拔除 感染 

分 类 号：R541.7[医药卫生—心血管疾病]