永久起搏器常见并发症的临床分析

Clinical analysis of the common complications in permanent cardiac pacemaker

目的探讨永久起搏器常见并发症发生原因、处理方法及预防措施。方法回顾分析新疆医科大学第一附属医院2005年1月～2008年4月安装永久起搏器患者456例临床资料的并发症。其中男性275例,女性181例;年龄28～91岁,平均年龄60.23岁;病态窦房结综合征287例,Ⅲ°房室传导阻滞97例,高度房室传导阻滞28例,Ⅱ°房室传导阻滞19例,扩张型心肌病12例,其他疾病13例。起搏器类型:单腔起搏器,双腔起搏器,三腔起搏器,埋藏式自动复律除颤器(ICD)。结果并发症共27例,其中误穿刺入锁骨下动脉4例,气胸1例,冠状静脉窦口夹层1例,冠状静脉注入气泡1例,引流条断裂1例,电极接反2例,感知障碍2例,电池提前耗竭1例,起搏器综合征2例,起搏器介入的心动过速1例,电极脱位4例,囊袋血肿6例,囊袋感染1例。结论加深对起搏器常见并发症的了解,提高鉴别能力,重视术前预防,术中规范操作,加强术后随访及起搏器知识教育,早期发现积极处理各种并发症,可将并发症减少到最低限。

Objective To explore the causes of common complications in permanent pacemaker and its preventive and treatment measures. Methods From January- 2005 to April 2008 complications of 456 patients with pacemaker （male 275, female 181, aged 28 - 91 years, mean age 60.23 years ） were retrospectively analyzed. Among them there were 287 cases of sick sinus syndrome,97 Ⅱ° AVB,28 high degree AVB, 19 Ⅲ° AVB, 12 dilated cardiomyopathy,and 13 with other diseases. The types of installed pacemakers were single-chamber pacemaker,dual-chamber pacemaker,three-chamber pacemaker and inplantable cardiac defibrilator （ICD）. Results The patients with pacemaker complications were 27 cases after permanent cardiac pacemaker implantation ,4 of incorrect puncture in clavicle artery, 1 of pneumothorax, 1 of coronary vein dissection, 1 of injecting bubbles into coronary vein, l of drain strip split, 2 of electrode reverse linking,2 of perception disturbance, 1 of battery exhausting, 2 of pacemaker syndrome, l of pacemaker interventional tachycardia, 4 of electrode dislocation, 6 of pocket hematoma and 1 of pocket infection.Conclusion Together of the following measures eg. throughly understanding of the common complications, increased differential ability, paying attention to preoperative prevention, standardized operation procedure, closed following up as well as strengthen the education of pacemaker knowledge and early discovery and treatment of the complications would significantly decrease the complication occurrence rate of pacemaker implantation.