经静脉途径电极拔除对三尖瓣返流的急性期影响及危险因素分析  

Effect of transvenous lead extraction on acute tricuspid regurgitation and analysis of risk factors

作　　者：李继文[1] 陈轶[1] 黄克强 蒋萍[1] 苏晞[1] LI Ji-wen;CHEN Yi;HUANG Ke-qiang;JIANG Ping;SU Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,Hubei,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2021年第5期415-419,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的观察经静脉途径拔除电极导线对三尖瓣返流(TR)的急性期影响并分析相关危险因素。方法对2015年5月至2019年12月间接受经静脉途径电极拔除术的62例患者进行单中心回顾性分析。术中电极导线拔除前后应用经食管超声心动图测定TR情况,根据TR的严重程度分别从0到5的进行TR评分(0=无返流,1=轻度,2=轻中度,3=中度,4=中重度,5=重度)。有临床意义的TR加重被定义为电极导线拔除后至少增加2分或TR评分至少3分以上。结果术中总共拔除了125根电极导线,拔除前TR评分为1.37±0.99,拔除后的TR评分为1.77±1.09,电极拔除前后TR评分比较,差异具有显著性(P<0.01)。其中6例(9.7%)的TR评分较电极拔除前显著增加(增加2分或术后评分至少3分以上)。多因素Logistic分析表明电极导线植入时间是经静脉途径电极拔除术中出现TR显著恶化的独立危险因素。结论经静脉途径电极导线拔除与术后即刻TR增加相关,其中少部分患者可发生有临床意义的TR加重恶化,而电极导线的植入时间是预测TR加重的独立危险因素。Objective To observe the effect of transvenous lead extraction on acute tricuspid regurgitation(TR) and analyze the related risk factors. Methods A single-center retrospective analysis was performed in 62 patients who underwent transvenous lead extraction from May 2015 to December 2019.TR was measured by transesophageal echocardiography before and after extraction of leads.TR scores were scored according to the severity of tricuspid regurgitation from 0 to 5(0=none, 1=mild, 2=mild/moderate, 3=moderate, 4=moderate/severe, 5 = severe).Clinically significant increase in TR was defined as an increase of at least 2 points or a TR score of at least 3 points after lead extraction. Results A total of 125 leads were extracted.The preprocedure and postprocedure TR score were 1.37±0.99 and 1.77±1.09(P<0.01).The TR score of 6 patients(9.7%) was significantly higher than that before lead extraction.Multivariate Logistic analysis showed that the lead age was an independent risk factor for significant deterioration of TR during transvenous lead extraction. Conclusion Transvenous lead extraction is related to the increase of TR,and a small number of patients may have clinical aggravation after operation.The lead age is an independent risk factor for predicting the aggravation of TR.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(5):415-419]

关 键 词：心血管病学 心血管植入性电子器械 经静脉途径电极拔除 三尖瓣返流 

分 类 号：R318.11[医药卫生—生物医学工程]