儿童安装永久性心脏起搏器方法的临床探讨

Discussion on the methods of pacemaker implantation in children

目的总结儿童永久性心脏起搏器植入、随访和并发症处理的经验。方法（1）对Ⅲ度房室传导阻滞儿童植入永久性心脏起搏器，术后1周，1、3、6、12个月及此后每年均进行随访，随访时行心电图、胸片、心脏超声心动图检查，并对起搏器参数和起搏闯值进行检测。（2）对随诊中出现的6例并发症（其中囊袋感染2例、固定胶套磨破皮肤感染2例、绝缘层破损1例、重度三尖瓣反流1例）分别进行处理。结果对27例植入永久性心脏起搏器的儿童进行7个月～8年随访，平均（5．2±1．5）年；其中6例并发症经处理后，感知和起搏功能良好，随访6个月～5年无异常。结论（1）儿童安装永久性心脏起搏器要严格掌握适应证，尽量采用生理性起搏；（2）心外膜手术创伤大，术后并发症少，适合超声心动图显示锁骨下静脉内径小于5mm的患儿；（3）心内膜植入时要注意儿童的心脏结构和生长发育特点。

Objective To review retrospectively experience of pediatric cardiac pacing. Methods （1） Twenty seven children who had been implanted pacemaker for complete atrioventricular block were fellowed up, at time of 1 week, 1 month, 3 months, 6 months, 1 year and per annum after operation. Every child was performed routine electrocardiogram, chest radiography and echocardiography, pacemaker parameter and pacing threshold were dectected. （2）Complications happened to 6 children, 2 had pocket infection-erosion, 2 had skin infection for abrasion of fix rubber slip, 1 had pacing functional disorder because the insulation of one ventricular lead was damaged, 1 had severe tricuspid regurgitation. Everyone of them had been given properly treat- ment. Results The 27 cases were followed up from 7 months to 8 years [ （5.2 ± 1.5）years] afer operation. Among them, all of 6 cases with complication had been successfully curred after reoperation, and they had never occured complication again after following 6 months to 5 years, because the same mistake had been avoided. Conclusion （1） It must be strictly controlled for the implantation of pacemaker in children, and installing DDD pacers should be selected as far as possible. （2）The patients have severe injury whom paced by epicardial leads, but seldomly occur complications. Epicardial pacing suits the patients with subclavian vein diameter measure less than 5mm by echocardiography. （ 3 ） Transvenous pacing must suit with the cardiac structure and growth of children.