摘要
背景永久性心脏起搏器植入术是临床治疗严重慢性心律失常的有效措施,而高龄患者的心内膜存在不同程度纤维化、肌小梁松弛等病理性改变,致使翼状被动固定电极在操作时易出现嵌顿,且在术中及术后易出现脱位。目前关于高龄患者行永久性心脏起搏器植入术方面的临床研究较少。目的探讨心房螺旋电极导线在高龄患者永久性心脏起搏器植入术中应用的可行性及安全性。方法选取2016年3月—2018年2月陕西省人民医院心内科行永久性心脏起搏器植入术的高龄患者78例,根据心房内植入电极类型分为螺旋电极组40例和翼状电极组38例。螺旋电极组患者心房电极固定于右心耳、前壁或侧壁,翼状电极组患者心房电极固定于右心耳。比较两组术中及术后1周、3个月、6个月、12个月心房电极起搏阈值、阻抗、感知及术中心房电极植入时间,并观察两组患者并发症发生情况。结果时间与方法在心房电极起搏阈值上存在交互作用(P<0.05);方法在心房电极起搏阈值上主效应显著(P<0.05);时间在心房电极起搏阈值上主效应显著(P<0.05)。螺旋电极组患者术中心房电极起搏阈值大于翼状电极组(P<0.05)。两组患者术后1周、3个月、6个月、12个月心房电极起搏阈值分别小于本组术中(P<0.05);翼状电极组术后12个月及螺旋电极组术后3个月、6个月、12个月心房电极起搏阈值分别小于本组术后1周(P<0.05)。时间与方法在心房电极阻抗、感知上不存在交互作用(P>0.05);方法在心房电极阻抗、感知上主效应不显著(P>0.05);时间在心房电极阻抗、感知上主效应不显著(P>0.05)。螺旋电极组患者术中心房电极植入时间短于翼状电极组(P<0.001)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论心房螺旋电极导线可使行永久性心脏起搏器植入术的高龄患者获得长期、稳定的起搏阈值、阻抗及
Background Implantation of permanent cardiac pacemaker is a effective measure in the treatment of severe bradyar rhythmias.But the endocardium of elderly patients have different degree of fibrosis,trabecular muscle relaxation and other anatomical characteristics.Thus,the wing-like passive fixed electrode is prone to incarceration during operation,and dislocation is easy to occur during and after operation.At present,there are few clinical studies on permanent pacemaker implantation in elderly patients.Objective To discuss feasibility and safety of atrium spiral electrode lead in elderly patients with implantation of permanent cardiac pacemaker.Methods A total of 78 elderly patients underwent implantation of permanent cardiac pacemaker were selected in Shaanxi Provincial People's Hospital from March 2016 to February 2018,and they were divided into spiral electrode group(n=40)and wing electrode group(n=38)according to types of electrodes implanted in atrium.Atrial electrodes of patients in spiral electrode group were fixed on the anterior or lateral wall of the right atrial appendage,and atrial electrodes of patients in wing electrode group were fixed on the anterior.The atrial electrode pacing threshold,atrial electrode impedance,atrial electrode sensing during operation,and at 1 week,3 months,6 months and 12 months after operation,atrial electrode implantation time were compared between the two groups,and the incidence of complications was observed in the two groups.Results There were interaction between treatment time and method on atrial electrode pacing threshold(P<0.05).The main effect of treatment method was significant on atrial electrode pacing threshold(P<0.05).And the main effect of treatment time was significant on atrial electrode pacing threshold(P<0.05).Atrial electrode pacing threshold during operation in spiral electrode group was larger than that in wing electrode group(P<0.05);atrial electrode pacing threshold at 1 week,3 months,6 months and 12 months after operation in the two groups was less th
作者
祁杰
吕颖
韩稳琦
程功
杨光
QI Jie;LYU Ying;HAN Wenqi;CHENG Gong;YANG Guang(Department of Cardiology 2,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Cardiology 1,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
出处
《实用心脑肺血管病杂志》
2021年第3期106-109,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
