经外科介入和外科手术移除起搏电极导线的回顾性分析  

The role of cardiac surgery in lead extraction procedure

作　　者：刘刚[1] 昃峰[3] 刘海峰 高卿[1] 王龙[3] 陈生龙[1] 陈彧[1] 李学斌[3] LIU Gang;ZE Feng;LIU Hai-feng;GAO Qing;WANG Long;CHEN Sheng-long;CHEN Yu;LI Xue-bin(Cardiac Surgery,Peking University,Beijing 100044,China;Cardiology Department of Heart Center,People's Hospital,Peking University,Beijing 100044,China;Department of Cardiology,Guangrao County Hospital,Guangrao 257300,Shangdong,China)

机构地区：[1]北京大学人民医院心脏中心心外科,北京100044 [2]山东广饶县人民医院心内科,山东广饶257300 [3]北京大学人民医院心内科,北京100044

出　　处：《中国心脏起搏与心电生理杂志》2021年第5期411-414,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的分析心脏外科医生在电极导线拔除工作中的参与程度,探讨外科方法在电极导线拔除治疗中的地位与作用。方法回顾性分析2012年1月1日至2018年12月31日在本院心脏中心行电极拔除治疗的所有病人资料,根据心外科参与程度分为介入组、杂交组及外科组。记录各组患者的年龄、性别、植入电极总数、植入装置类型、电极拔除原因、电极拔除方法、是否同期合并其它心血管合并症、术前左室射血分数(LVEF)、电极植入最长时间(年)、电极拔除过程是否发生严重并发症、是否住院死亡、病例结局(是否完全去除心内电极导线)等指标并进行分析。结果共计完成电极拔除1 124例,共计拔除电极导线2 106根。介入组1 087例,杂交组24例,外科组13例。此三组患者年龄、电极植入最长时间及电极数目不同(P=0.003,P<0.001,P<0.001);LVEF无差异(P=0.487)。电极拔除总成功率96%(1 113/1 124)。经静脉电极拔除过程中出现严重并发症23例,其中外科干预12例,11例需要急诊外科干预。全部患者共计49例需要外科直接参与手术。结论心内起搏导线可以通过传统外科、杂交技术及经静脉介入方法拔除。在电极导线拔除过程中,心脏外科医生的作用有后备支持、积极参与和完全主导三类。心脏外科是开展心内电极导线经静脉拔除的必要保障条件。约3%~4%的患者需要心脏外科医生直接参与治疗。Objective To determine the involvement and the role of cardiac surgery in lead extraction procedure. Methods All patients who underwent transvenous lead extraction in heart center of People′s Hospital between Jan 1 st 2012 and Dec 31 st 2018 were included in this analysis. Patients were divided into intervention group(group 1), hybrid group(group 2) and surgery group(group 3). All medical records were reviewed and data pertaining to patient demographics, type of devices, dates from original device implantation, number of all total leads extracted, left ventricular lead extracted, techniques of extraction, complications, in-hospital death and outcomes were recorded and described. Results A total of 2 106 leads were removed from 1 124 patients during studying period. There were 1 087 cases in group 1, 24 cases in group 2 and 13 cases in group 3. There were differences among these 3 group in age, dates from original device implantation and number of total lead extracted(P=0.003,P<0.001,P<0.001). And there were no differences in left ventricle ejection fraction(LVEF)(P=0.487). The total successful extraction rate was 96%. Twenty-three major complications occurred and 11 cases endured emergency open-heart surgery. There were 49 cases received cardiac surgery altogether. Conclusion Lead removal can be implemented transvenously, surgically or by hybrid ways. Cardiac surgery plays roles as backup, participation and domination in lead extraction procedure. Cardiac surgery support is a mandatory component of lead extraction operation.And there are 3%-4% patients need cardiac surgery during this operation.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(5):411-414]

关 键 词：心血管病学 心脏外科 电极拔除术 并发症 角色 

分 类 号：R318.ll[医药卫生—生物医学工程]