埋藏式心脏转复除颤器在儿童及青少年中的应用及随访  

Application and follow-up of implantable cardioverter defibrillator for children and adolescents

作　　者：李稚灵 曾少颖[1] 张智伟[1] 梁东坡[1] 刘甜[1] 王树水[1] 李渝芬[1] Li Zhiling;Zeng Shaoying;Zhang Zhiwei;Liang Dongpo;Liu Tian;Wang Shushui;Li Yufen(Department of Pediatric Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,广东省华南结构性心脏病重点实验室,广东省人民医院广东省医学科学院心儿科,广州510080

出　　处：《中华实用儿科临床杂志》2020年第19期1472-1475,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨埋藏式心脏转复除颤器(ICD)在预防儿童及青少年心源性猝死中的应用、不良事件的处理及随访研究。方法收集2008年1月至2019年3月在广东省人民医院心儿科植入ICD的19例患儿(男12例,女7例)既往住院及门诊资料,包括病史、ICD植入方式、ICD术后程序控制、抗心律失常药物的使用及ICD恰当/不恰当放电和心室电风暴的处理,并做随访研究。结果共纳入19例患儿,植入术前均出现过1次或多次晕厥,植入ICD时的年龄为(12.30±2.08)岁,体质量为(40.00±13.93)kg。11例植入胸大肌下间隙,6例植入胸大肌筋膜下间隙,2例分别植入左侧腹部及左侧腋下。患儿术后均口服抗心律失常药物。随访时间为3.2年(0.3~11.1年),患儿均存活,无电极断裂、脱位、静脉血栓、心脏穿孔、囊袋血肿、破溃、感染等并发症发生。12例(63.2%)患儿有放电治疗事件,包括10例(83.3%)恰当识别/治疗事件,2例(16.7%)不恰当识别/治疗事件,其中5例出现心室电风暴。7例(36.8%)ICD具有远程监测系统,其中4例(57.1%)监测到不良反应,通过线上和线下的及时处理,避免了不良后果的发生。结论ICD是目前预防儿童及青少年心源性猝死最可靠的方法,需根据年龄、体质量和发育条件选择不同的植入方式;术后恰当/不恰当放电治疗事件,需及时明确病因、优化药物治疗、必要时行射频消融术。Objective To explore the application of implantable cardioverter defibrillator(ICD)in the prevention of sudden cardiac death for children and adolescents,the treatment of adverse events and follow-up studies.Methods A total of 19 pediatric patients(12 males,7 females)were admitted in the Department of Pediatric Cardio-logy,Guangdong Provincial People′s Hospital from January 2008 to March 2019,and their previous inpatient and outpatient data including medical history,ICD implantation method,postoperative program control,the use of antiarrhythmic drugs,proper/improper discharge of ICD and management of ventricular electrical storm were collected retrospectively and follow-up study was carried out.Results A total of 19 pediatric patients were included,all of whom had once syncope or more before ICD implantation.The age at the time of ICD implantation was(12.30±2.08)years,and the weight was(40.00±13.93)kg.Eleven patients were implanted in the subpectoralis major space,6 cases in the subfascial space,and 2 cases in the left abdomen and left armpit,respectively.All patients received oral antiarrhythmic drugs after surgery.The follow-up period was 3.2 years(0.3-11.1 years).All the children survived without complications such as electrode fracture,dislocation,venous thrombosis,cardiac perforation,capsular hematoma,rupture,and infection.Twelve cases(63.2%)had discharge events,including 10 cases(83.3%)of appropriate recognition/treatment events,and 2 cases(16.7%)of inappropriate recognition/treatment events,while 5 cases were ventricular electrical storms.Totally,7 ICD cases(36.8%)were equipped with remote monitoring system,and 4 cases(57.1%)were detected whit adverse reactions,which were timely handled online and offline,thus avoiding adverse consequences.Conclusions Currently,ICD is the most effective treatment for the prevention of sudden cardiac death in children and adolescents.According to age,weight and developmental conditions,different implantation methods should be selected.Appropriate/inappropriate discharge

关 键 词：埋藏式心脏转复除颤器 心源性猝死 随访 儿童 

分 类 号：R725.4[医药卫生—儿科]