植入较短时间导线拔除的策略与预后分析  

Strategy and prognosis analysis of wire removal after short implantation

作　　者：胡凯 吴国宏 严激 苏浩 Hu Kai;Wu Guohong;Yan Ji;Su Hao(Department of Cardiovascular Medicine,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230002,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)心血管内科,合肥230002

出　　处：《中华心律失常学杂志》2022年第6期516-521,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的分析经静脉移除心血管植入型电子器械(CIED)患者的病因、手术策略、并发症及预后。方法本研究为单中心回顾性研究,连续入选2015年1月至2021年12月就诊于中国科学技术大学附属第一医院心内科的经静脉拔除CIED导线的患者。拔除过程中首先尝试使用简单的手动牵引,如果失败则使用锁定探针锁定后手动牵引,仍不能有效拔除者则联合机械扩张鞘(Evolution)拔除。收集并分析CIED导线拔除病因、合并症、器械类型、并发症和预后情况。结果研究入选74例患者,年龄(66.20±14.61)岁,其中男49例(66.2%,49/74)拔除的161根导线,平均年限为4.5年,其中普通钢丝拔除导线平均年限为1.3年,单独锁定探针拔除导线平均年限为3.1年,锁定探针联合机械扩张鞘拔除导线为6.4年,导致导线拔除的主要原因为感染因素(94.6%,70/74)。所有需拔除导线均成功拔除,手动牵引(普通钢丝和/或单纯锁定钢丝直接牵拉)拔除导线31例(41.9%,31/74),锁定探针联合机械扩张鞘拔除43例,不同导线拔除方式患者CIED导线植入年限差异有统计学意义[(1.84±1.57)年对(6.44±3.88)年,P<0.001)]。拔除导线后出现并发症与未出现并发症患者使用扩张机械鞘的比例[45.5%(5/11)对60.3%(38/63),P=0.510]和年龄[(73.18±12.65)岁对(65.00±14.67)岁,P=0.070)]差异无统计学意义。同时发现54.1%(40/74)患者起搏器破溃部位位于囊袋外侧,6例患者破溃位于内侧;58例患者经锁骨下静脉途径拔除,16例经锁骨下静脉和下腔静脉途径拔除。所有患者术后均常规应用抗生素预防感染,72例患者手术完全成功,2例临床成功但残留小部分导线,不影响预后。在起搏器拔除过程中未出现重大并发症,切口愈合不良10例,下肢静脉血栓1例,未发生与手术相关的死亡。结论感染是起搏器导线拔除的首要原因,不同导线拔除方式患者CIED植入时间差异有统计学意义,早期植入患者可依靠�Objective To analyze the etiology,surgical strategies,complications and prognosis of patients with transvenous removal of electronic devices for cardiac implantation.Methods This study was a single-center retrospective analysis,the patients with pacemaker leads removed via vein in the Department of Cardiology of First Affiliated Hospital of the University of Science and Technology of China were reviewed consecutively.During the removal process,begins with a simple manual traction using a conventional non-locking needle.If it failed,manual traction was used after locking with a locking probe,and those who still cannot be effectively removed,in conjunction with Evolution’s mechanical expansion sheath.The etiology,comorbidities,device types,complications and prognosisl were collected.Results A total of 74 patients were included,including 49 males,and the mean age(66.20±14.61)years old.The average age of the 161 electrodes removed was 4.5 years.Among them,the average life of ordinary wire extraction wire is 1.3 years,the average life of separate locking stylets extraction wire is 3.1 years,and the locking stylets combined with mechanical expansion sheath extraction wire is 6.4 years,The main reason for electrode removal was infection(94.6%,70/74).all the wires that needed to be removed were successfully removed.A total of 31 cases were removed using simple manual traction(ordinary wire/locking stylet),the locking probe combined with mechanical dilation sheath removal accounted for 43 cases.There was a significant difference in CIED lead implantation years in patients with different lead removal methods[(1.84±1.57)years vs.(6.44±3.88)years,P<0.001)].There was no significant difference in the use of mechanical dilatation sheaths[45.5%(5/11)vs.60.3%(38/63),P=0.510],and age[(73.18±12.65)years vs.(65.00±14.67)years,P=0.070)]between patients who had complications after wire removal and patients who did not.Forty patients had pacemaker rupture at the lateral side and 6 patients had the medial ruptures,and 58 patients

关 键 词：心脏起搏器 人工 导线拔除 感染 锁定探针 机械扩张鞘 

分 类 号：R654.2[医药卫生—外科学]