80岁以上高龄患者心脏永久起搏器植入术的临床分析

Pacemaker implantation in patients aged over 80 years:report of 125 cases

目的探讨80岁以上患者心脏永久起搏器植入术的可行性和安全性。方法选取1997年1月至2007年12月沈阳军区总医院收治的80岁以上心脏首次永久起搏器植入患者125例(高龄组)。与同期首次植入心脏永久起搏器570例65～79岁的患者(老年组)进行对比分析,观察两组的临床资料、手术成功率、围术期并发症发生率等指标。结果高龄组患者多种心脏疾病(除手术适应证疾病外)并存及合并心脏外疾病较老年组均明显增多。两组手术成功率均为100%。高龄组125例患者共植入单腔起搏器69台、双腔起搏器50台、三腔起搏器4台、双腔ICD2台。高龄组患者手术耐受性差,与老年组比较围术期并发症发生率明显增加。因手术操作引起的围术期并发症两组无明显差异。经及时发现并采取相应措施后,并发症均好转。所有患者均存活出院。结论充分考虑80岁以上老年患者心脏疾病的特点,并加强围术期管理,可避免和减少并发症的发生,其行心脏永久起搏器植入术是可行和安全的。

Objective To estimate the safety and feasibility of permanent pacemaker implantation in patients over 80 years old. Methods Totally 125 patients aged over 80 years （very old group） who underwent permanent pacemaker implantation in General Hospital of Shenyang Military Command from January 1997 to December 2007 were selected. Another 570 elderly patients aged 65 to 79 years （elderly group）, who received similar procedures during the corresponding period, served as controls. The clinical data, success rate of the procedures, and perioperative complications incidence rate were compared between the two groups. Results The concomitance of multiple heart diseases （except the indications of pacemaker implantation） and the combinations of non-heart diseases were more frequent in very old group than in elderly group. The success rate of the procedures was 100% in both two groups. In very old group, single-chamber pacemaker was used in 69 patients, dual-chamber pacemaker in 50 patients, threechamber pacemaker in 4 patients, and dual-chamber pacemaker combined with ICD in 2 patients. The patients in very old group had poor tolerance to the procedures and high perioperative complications incidence rate. The manipulation associated perioperative complications incidence rate was not significantly different between the two groups. All com- plications were alleviated following effective treatment. All patients survived till being discharged from hospital. Con- clusion It is possible to avoid and decrease perioperative complications by considering the clinical features of heart diseases and improving perioperative management in over 80 years old patients, therefore it is safe and feasible to perform pacemaker implantation in patients over 80 years.