未成年患者经心内膜植入永久起搏器的病因分析及随访观察  

Etiological analysis and follow-up observation of permanent endocardial pacemaker implantation in minor patients

作　　者：林小花 张建成[2] 张彦 LIN Xiaohua;ZHANG Jiancheng;ZHANG Yan(Department of Cardiology,1.the First Affiliated Fuzhou Hospital of Fujian Medical University,Fuzhou Fujian 350009;Fujian Provincial Hospital,Fuzhou Fu-jian 350001,China)

机构地区：[1]福建医科大学附属福州市第一医院心血管内科,福建福州350009 [2]福建省立医院心血管内科,福建福州350001

出　　处：《实用心电学杂志》2021年第3期215-219,共5页Journal of Practical Electrocardiology

基　　金：福州市市级重点专科资助项目(20192005)。

摘　　要：目的研究未成年患者经心内膜植入永久起搏器的病因构成及不同起搏部位与模式对心功能的影响。方法回顾性分析17例经心内膜植入永久起搏器的未成年患者临床资料,并随访患者的术后心电图、心脏正侧位片、心脏彩超及起搏参数等。结果 17例患者的原发病构成:病毒性心肌炎后遗留三度房室阻滞7例,复杂先天性心脏病术后出现的三度房室阻滞6例,不明原因致病态窦房结综合征伴扩张型心肌病2例,不明原因致三度房室阻滞2例。按照植入起搏器的类型分类,10例为单腔心室起搏,7例为双腔起搏。16例患者手术过程顺利,1例患者植入起搏器后因原发病死亡。术后对13例患者平均随访3.1年。13例术后均在门诊行起搏器程控随诊,其中7例为VVI(R)起搏模式,6例为DDD(R)起搏模式。心脏彩超检测数据显示,采用VVI(R)起搏模式的病例右心房内径(RAD)和左心室内径(RVD)术后均明显扩大(P均<0.05)。无论是心室心尖还是室间隔部位起搏,术后左室舒张末期内径、RVD及左室射血分数与术前比较,差异均无统计学意义。术后随访1年、2年、3年,右室起搏阈值、阻抗、百分比及灵敏度均无变化。术后起搏器工作良好,均未出现术后并发症。2例患者因起搏器电池耗竭,分别于7年及14年后行起搏器电池置换术。结论未成年人经心内膜植入永久起搏器的主要病因有病毒性心肌炎导致的房室阻滞,其次为复杂先天性心脏病术后出现的房室阻滞,不明原因导致的病窦综合征罕见。经心内膜植入永久起搏器时电极导线要预留足够长度;起搏模式及起搏部位对左室结构和功能无明显影响。Objective To study the etiological composition of permanent endocardial pacemaker implantation in minor patients,and the influence of different pacing locations and modes on cardiac function.Methods We retrospectively analyzed the clinical data of 17 minor patients implanted with permanent endocardial pacemaker.Their ECG,anterolateral radiography of the heart,color Doppler echocardiography and pacing parameters of pacemaker after implantation were followed up.Results The primary disease composition of 17 minors is as follows:7 cases of third-degree atrioventricular block resulted from viral myocarditis,6 cases of third-degree atrioventricular block after complex congenital heart disease surgery,2 cases of unexplained sick sinus syndrome complicating dilated cardiomyopathy and 2 cases of unexplained third-degree atrioventricular block.Classified by the types of implanted pacemakers,there are 10 cases of single-chamber ventricular pacing and 7 cases of dual-chamber pacing.The operation goes smoothly in the enrolled patients except for one patient who died of primary disease after the implantation.Thirteen patients are followed up for an average of 3.1 years after the surgery.The pacemaker programmability of these 13 patients are followed up in the outpatient department;VVI(R)pacing mode and DDD(R)pacing mode are separately applied in 7 and 6 patients.Color Doppler echocardiography results show that right atrium diameter(RAD)and right ventricular diameter(RVD)of the cases in VVI(R)pacing mode both significantly increase after the surgery(P<0.05).There is no statistically significant difference in LVED,RVD and LVEF before and after the operation whether pacing in ventricular apex or septum.There is no difference in the right ventricular pacing threshold,impedance,percentage,and sensitivity 1 year,2 years and 3 years after the surgery.The pacemakers function well after the operation whithout postoperative complication.Pacemaker battery replacement was performed in 2 patients due to pacemaker battery depletion separate

关 键 词：未成年人 永久起搏器 病毒性心肌炎 先天性心脏病 三度房室阻滞 

分 类 号：R541.7[医药卫生—心血管疾病]