老年患者的起搏治疗和预后分析

Pacemaker therapy in elderly and very elderly patients:comparison study of implantation parameters and prognosis.

目的对比高龄与低龄老年患者心脏永久起搏器植入时的参数及并发症,观察患者生存年限。方法回顾性分析我院1989年至2004年永久起搏器植入患者的临床资料,以90例高龄心脏永久起搏器植入患者为研究组,以同期、同病因、同起搏器类型的低龄老年心脏永久起搏器植入患者为对照组,进行对比分析。结果研究组心室起搏阈值为(0.54±0.38)V,感知为(12.99±5.31)mV,阻抗为(718.45±218.86)Ω,心房起搏阈值为(0.68±0.28)V,感知为(2.77±1.10)mV,阻抗为(643.84±234.25)Ω,产生手术并发症有7例;对照组心室起搏阈值为(0.49±0.29)V,感知为(12.26±5.45)mV,阻抗为(778.95±321.57)Ω,心房起搏阈值为(0.59±0.24)V。感知为(2.91±1.38)mV,阻抗(667.6±183.41)Ω,产生手术并发症有5例。2组起搏器植入时的参数及并发症无统计学意义。高龄与低龄老年心脏永久起搏器植入患者的五年生存率分别为56.77%和78.17%。结论高龄与低龄老年患者起搏治疗均安全有效,起搏植入参数及术后并发症无统计学意义,高龄老年患者术后需要加强监测和护理,高龄老年患者起搏治疗长期预后理想。

Objective To compare pacemaker parameters and follow -up results between very elderly and elderly patients with permanent pacemaker implantation. Methods Between 1989 and 2004, 90 very elderly patients （aged over 80 years） and 90 elderly patients （age between 60 to 80 years old） were matched in this comparison study, according to pacemaker mode and basic heart disease. Pacing thresholds, sense amplitudes, as well as leads impendence were measured at implantation. After implantation, all patients were followed up with standardized methods. Results Pacing thresholds, sensing amplitudes and leads impendence for ventricle were 0. 54 ±0. 38V,12. 99 ±5. 31mv,718.45 ±218.86Ω respectively in very elderly patients, and were 0. 49 ±0. 29V, 12.26 ± 5.45mv, 778.95 ± 321.57Ω in very elderly patients, no significant differences were found. Pacing thresholds, sensing amplitudes and leads impendence for atrium were 0. 68 ± 0. 28 V,2. 77 ± 1.10mV,643. 84 ± 234. 25Ω in very elderly patients, and were 0. 59 ±0. 24V,2. 91 ± 1.38mv,667. 6 ± 183.41Ω in elderly patients, no significant differences were found. Complication rate after pacemaker implantation in very elderly patients and elderly patients respectively, showing no statistical difference. Five - year survival after pacemaker implantation was 56. 77% in very elderly patients and was 78. 17% in elderly patients. Conclusion There are no significant differences in implantation parameters and complications between elderly patients and very elderly patients. The long - term prognosis of permanent pacemaker implantation for very elderly patients is good.