85岁以上高龄老年人起搏器治疗的安全性和长期预后分析

The long-term prognosis and safety of pacemaker treatment in very elderly patients aged over 85 years

目的探讨年龄≥85岁高龄老年人起搏器治疗的安全性及近、远期疗效。方法选择首次安装永久起搏器,资料完整的老年患者142例,分为高龄组(≥85岁)69例和普通老年组(65～84岁)73例,比较2组术中起搏阈值、阻抗、感知、平均生存时间及5年生存率。结果高龄组与普通老年组在术中起搏阈值、阻抗、感知及平均生存时间、5年生存率等方面差异无统计学意义(P>0.05)。142例患者中,房室全能型5年生存率为71%,心室按需型5年生存率为47%,房室全能型5年生存率明显高于心室按需型5年生存率,差异有统计学意义(P<0.05)。结论只要术前充分准备,术中谨慎操作,高龄老年患者行永久起搏器治疗是安全有效的,对于有房室全能型起搏器适应证的患者,仍应首选房室全能型起搏方式。

Objective To evaluate the long-term curative effect and safety of pacemaker treatment in very elderly patients aged over 85 years. Methods A total of 142 elderly patients with complete information who received first implantation of permanent pacemakers were selected. They were divided into two groups,the very elderly group included 69 patients who were 85 years old or over,and the general elderly group included 73 patients aged 65 to 84 years. The differences in threshold,impedance, perception, average survival time and 5-year survival rates were compared between the two groups. Results There was no significant difference in threshold of pacing, impedance,perception, average survival time and 5-year survival rate （P ~ 0. 05） between the 2 groups. There was significant difference between DDD and VVI pacing modes in 5-year survival rates which were 71% and 47% respectively （P 〈0.05）. Conclusion With careful preoperative preparation and cautious intra-operative operation,the permanent pacemaker treatment is safe and effective for the very elderly patients. DDD pacemaker is still the first choice for appreciated patient even if he is very old.