临时心脏起搏器抢救心血管急危重症患者的临床观察

Clinical investigation of temporary heart pacemaker for emergency treatment of patients with acute and severe cardiovascular diseases

目的评估临时心脏起搏器抢救心血管急危重症患者的临床疗效和安全性。方法回顾性分析2007年8月至2015年12月河南省人民医院急诊内科抢救的因不同病因引起的心脏骤停和缓慢型心律失常患者147例的临床资料。根据抢救时是否实施临时心脏起搏，将患者分为观察组（80例）给予临时心脏起搏治疗，其中心脏骤停49例，缓慢型心律失常31例；对照组（67例）给予传统心肺复苏和药物治疗，其中心脏骤停39例，缓慢型心律失常28例。比较两组患者的抢救成功率和并发症情况。结果观察组患者的总体抢救成功率为96．3％，明显高于对照组（44．8％）（P〈0．05）。观察组中39例（95．1％）心脏骤停患者抢救成功，抢救成功率明显高于对照组18例（45．1％），并且观察组中38例（97．4％）缓慢型心律失常患者抢救成功，抢救成功率明显高于对照组12例（44．4％）（均P〈0．05）。心脏临床起搏患者中4例（5％）患者出现并发症，其中心包积液（1例），室颤（1例），导管脱位（2例）。结论临时心脏起搏器在抢救心血管急危重症患者中疗效显著，安全性高，可明显提高抢救成功率，值得临床上进一步推广应用。

Objective To investigate the clinical efficacy and safety of temporary heart pacemaker for emergency treatment of patients with acute and severe cardiovascular diseases. Methods The clinical data of 147 patients with cardiac arrest or bradyarrhythmia from August 2007 to December 2015 ,was analyzed retrospectively in Department of internal and Emergency Medicine, People＇s Hospital of Henan. Based on the rescue methods, all patients were divided into two groups： observation group （80 cases, among whom, 49 cases with cardiac arrest and 31 cases with bradyarrhythmia） and control group （67 cases, among whom 39 cases with cardiac arrest and 28 cases with bradyarrhythmia）. Patients in observation group received temporary heart pacemaker, and patients in control group received traditional cardio-pulmonary resuscitation and drug treatment. The rate of rescue and complications were analyzed and compared in two groups. Results The total rescue rate in observation group was 96. 3%, which was significantly higher than that in control group （44. 8 % ） （P 〈0. 05）. Further analysis showed that the rescue rate of patients with cardiac arrest in observation group was significantly higher than that in control group （ 95.1% vs 45.1% ） （ P 〈 0. 05）, and the rescue rate of patients with bradyarrhythmia in observation group was significantly higher than that in control group （97.4% vs 44. 4% ） （ P 〈 0.05 ）. Complications were observed in 4 patients ： pericardial effusion （1 case ）, ventricular fibrillation （1 cases ） and catheter dislocation （2 cases ）. Conclusion Temporary heart pacemaker was safe and effective in the treatment of patients with acute and severe cardiovascular diseases with improved rescue rate.