经静脉植入埋藏式心脏复律除颤器的临床应用分析  

Clinical application of transvenous implantable cardioverter defibrillator

作　　者：李淑敏[1] 郭涛[1] 韩明华[1] 刘中梅[1] 赵玲[1] 戴青原[1] 

机构地区：[1]昆明医学院第一附属医院心内科,云南昆明650032

出　　处：《云南医药》2003年第5期355-358,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的　通过对 2 1例植入埋藏式心脏复律除颤器 (ICD)的临床应用分析 ,探讨ICD在恶性室性心律失常中的治疗作用、参数设定、并发症及随访结果。方法　 2 1例均植入成功 ,其中单腔ICD 18例 ,双腔ICD 3例。心室起搏阈值 0 3～ 0 9(0 6 8± 0 2 1)V ,R波振幅 5 5～ 2 0 (10 0± 3 8)mV ,除颤阻抗 14～ 73(5 0 2±9 3)Ω ,除颤阈值 5～ 15 (12 5± 4 7)V。随访 3～ 5 7(2 5 3± 11 7)月 ,17例接受了成功的ICD治疗 ,2例发生误放电治疗 ,经重新调整参数后未再发生误放电 ,1例出现囊袋血肿 ,经处理好转 ,2例因电池耗竭更换了ICD装置 ,2例死亡 ,其中 1例为自杀 ,另 1例拒绝治疗和随访 ,室颤反复发作死亡。结果　ICD能有效转复恶性心律失常 ,双腔ICD能提高对室性和室上性快速性心律失常的鉴别 ,降低不适当ICD治疗 ;Objective To explore the efficacy,parameter setting,complicatio ns and follow-up results of implantable cardioverter defibrillator(ICD) to treat malignant ventr icular tachyarrhythmia.Methods 21 patients aged of 26～79 were chosen in this s tudy.The underlying diseases were cardiomyopathy(4 patients),LQTS(3 patients),co ronary heart disease(6 patients),hypertensive heart disease(6 patients),sick sin u s syndrome(1 patient),and myocarditis with three degree atrioventricular block(1 patient).18 of the 21 ICDs were single-chamber ICD,3 were dual-chamber ICD.Th e ventricular pacing threshold was 0 3V～0 9V,the amplitude of R wave was 5 5m V ～20mV,the shocking impedance was 14Ω～73Ω,the defibrillation threshold was 5V ～15V.During following-up of 3～57 months,17 patients received successful ICD t h erapy.Fault shock occurred in two patients.After resetting the parameter,fault s hock disappeared.One patient showed sack hematoma,and improved after treatment.T he ICD devices of two patients were changed due to battery burnout.Two patients died,one of them suicided,and the other died of VF recurrence resulting from his refusing treatment and follow-up.Conclusion ICD can convert m alignant ventricula r tachyarrhythmia effectually.The dual-chamber ICD can enhance the differential diagnoses between ventricular tachyarrhythmia and supraventricular tachyarrhythm ia,reduce improper ICD therapy.It can be useful to recognize and treat ventricul ar tachyarrhythmia if reinforcing follow-up and correcting the parameter in tim e .At the same time we must pay attention to the additional treatment of the drugs ,improve heart function and strengthen the mental education to the patients.

关 键 词：埋藏式心脏复律除颤器 室性心律失常 随访 

分 类 号：R541.7[医药卫生—心血管疾病]