新型无导线起搏与经静脉起搏围手术期恢复情况的对比研究  

Comparative study on perioperative recovery between de novo leadless pacing and transvenous pacing

作　　者：王冬雪 刘晓宇[1] 张常莹[1] 郑杰[1] 王如兴[1] WANG Dongxue;LIU Xiaoyu;ZHANG Changying;ZHENG Jie;WANG Ruxing(Department of Cardiology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院心内科,江苏无锡214023

出　　处：《实用心电学杂志》2024年第6期601-605,612,共6页Journal of Practical Electrocardiology

基　　金：国家自然科学基金资助项目(82000317,82370342);无锡市卫生健康委中青年拔尖人才资助项目(BJ2023006)。

摘　　要：目的比较新型无导线起搏(leadless pacemaker,LPM)和双腔经静脉起搏(transvenous pacemaker,TPM)在围手术期患者恢复情况方面的差异。方法回顾性分析12例新型LPM治疗患者和136例双腔TPM治疗患者临床资料,应用倾向性评分匹配后,选取LPM患者(LPM组)和双腔TPM患者(TPM组)各11例。评估患者术后平均住院天数和伤口恢复情况。分别应用疼痛视觉模拟评分(visual analogue scale,VAS)和改良Barthel指数(modified Barthel index,MBI),评估术后当天、术后第1天、术后第2天及出院当天两组患者疼痛程度和日常生活活动的功能状态。结果LPM组术后平均住院天数短于TPM组[(1.6±0.7)d vs.(3.1±0.3)d,P<0.01],伤口平均愈合时间也短于TPM组[(1.1±0.3)d vs.(2.6±0.8)d,P<0.01]。LPM组术后当天[(1.5±0.7)分vs.(4.5±0.8)分,P<0.01]、术后第1天[(0.5±0.5)分vs.(4.0±0.6)分,P<0.01]、术后第2天[0分vs.(2.4±0.5)分,P<0.01]和出院当天[0分vs.(0.5±0.5)分,P=0.005]的疼痛VAS评分均低于TPM组。LPM组术后第1天[(75.6±5.3)分vs.(53.6±2.3)分,P<0.01]、术后第2天[(93.6±6.4)分vs.(55.6±2.3)分,P<0.01]和出院当天[(95.5±5.8)分vs.(89.9±4.7)分,P=0.024]的MBI均高于TPM组。结论与双腔TPM治疗相比,新型LPM治疗具有患者围手术期恢复快的临床优势。Objective To compare perioperative recovery outcomes between de novo leadless pacing and dual-chamber transvenous pacing therapies.Methods A retrospective analysis was performed on clinical data of 12 patients undergoing de novo leadless pacemaker(LPM) implantation and 136 patients undergoing dual-chamber transvenous pacemaker(TPM) implantation.By propensity score matching,11 patients implanted with LPM(LPM group) and 11 patients implanted with dual-chamber TPM(TPM group) were selected.The average postoperative hospitalization days and wound recovery of patients were evaluated.Pain visual analogue scale(VAS) and modified Barthel index(MBI) were separately applied to evaluate the degree of pain and functional status of daily living activities in the two groups of patients on postoperative day,postoperative day 1 and 2,and on the day of discharge.Results The average postoperative hospitalization days of the LPM group was shorter than that of the TPM group [(1.6±0.7) days vs.(3.1±0.3) days,P<0.01],while the average wound healing time was also shorter than that of the TPM group [(1.1±0.3) days vs.(2.6±0.8) days,P<0.01].The pain VAS scores of the LPM group were lower than those of the TPM group on postoperative day [(1.5±0.7) points vs.(4.5±0.8) points,P<0.01],postoperative day 1 [(0.5±0.5) points vs.(4.0±0.6) points,P<0.01],postoperative day 2 [0 vs.(2.4±0.5) points,P<0.01],and on the day of discharge [0 vs.(0.5±0.5) points,P=0.005].The MBI values of the LPM group were all higher than those of the TPM group on postoperative day 1 [(75.6±5.3) points vs.(53.6±2.3) points,P<0.01],postoperative day 2 [(93.6±6.4) points vs.(55.6±2.3) points,P<0.01],and on the day of discharge [(95.5±5.8) points vs.(89.9±4.7) points,P=0.024].Conclusion De novo LPM therapy proves to be superior to dual-chamber TPM therapy with clinical advantages in rapid perioperative recovery of patients.

关 键 词：无导线起搏 心血管介入 康复 围手术期 

分 类 号：R540.4[医药卫生—心血管疾病]