心外膜永久性起搏器植入术治疗小儿严重缓慢型心律失常的疗效及随访分析  

Follow⁃up and efficacy of treating severe bradycardia with epicardial permanent pacemaker implantation

作　　者：刘湘 马力 邹明晖 夏树亮 崔彦芹 陈欣欣 李凤香 Liu Xiang;Ma Li;Zou Minghui;Xia Shuliang;Cui Yanqin;Chen Xinxin;Li Fengxiang(Heart Center,Guangzhou Women and Children's Medical Center,Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心心脏中心,广东省结构性出生缺陷疾病研究重点实验室,广州510623

出　　处：《中华小儿外科杂志》2022年第5期415-418,共4页Chinese Journal of Pediatric Surgery

基　　金：广州市科技计划项目(202102021149)。

摘　　要：目的探讨心外膜永久性起搏器植入治疗小儿严重缓慢型心律失常的疗效和经验。方法收集2010年7月27日至2020年7月28日在广州市妇女儿童医疗中心接受永久性起搏器植入术的患儿共52例,其中男25例,女27例,年龄为338 d(143~1696 d),体重为7.3 kg(5.1~14.3 kg)。所有手术由同一组外科医师完成。应用SPSS 20.0统计软件进行数据录入和分析。结果先天性心脏病术后并发Ⅲ度房室传导阻滞占76.9%(40/52),先天性Ⅲ度房室传导阻滞占21.2%(11/52),病态窦房结综合征占1.9%(1/52)。术后随访时间中位数35.3个月(11.5~71.4个月)。术后并发症发生率为9.6%(5/52),死亡率为7.7%(4/52)。与植入起搏器即刻比较,患儿末次随访的起搏阻抗出现明显下降(P=0.019),心室夺获阈值出现明显上升(P=0.009),起搏功能良好。结论永久起搏器植入术治疗小儿严重缓慢型心律失常安全有效,远期并发症发生率和死亡率低,但应关注起搏器导线断裂和功能障碍等问题。Objective To summarize the institutional experiences of treating severe bradycardia with epicardial permanent pacemaker implantation.Methods From July 2010 to July 2020,clinical data were retrospectively reviewed for 52 hospitalized children with severe bradycardia.There were 25 boys and 27 girls with a median age of 338(143-1696)days and a median weight of 7.3(5.1-14.3)kg.All operations were performed by the same group of surgeons.Clinical data were processed by SPSS 20.0.Results There were complete atrioventricular block complicated by cardiac surgery(n=40,76.9%),congenital complete atrioventricular block(n=11,21.2%)and sick sinus syndrome(n=1).The median follow-up period was 35.3(11.5-71.4)months.Among these patients 5(9.6%)developed complications,4(7.7%)died.As compared with immediate postoperative data,pacing impedance declined(P=0.019)and capture threshold spiked markedly at the last follow-up(P=0.009).However,pacing function was decent.Conclusion Epicardial permanent pacemaker implantation is both effective and safe for children with severe bradycardia.There is a low risk of complications and mortality and medium/long-term outcomes are satisfactory.However,clinicians should pay close attention to the problems of pacemaker leading to fracture and dysfunctions.

关 键 词：心脏起搏器 人工 心律失常 儿童 随访 

分 类 号：R726.5[医药卫生—儿科]