右心室流出道高位间隔部起搏的应用及护理

Application and nursing of right ventricular outflow tract high septum pacing

目的 探讨主动固定电极行右心室流出道高位间隔部起搏的可行性及护理对策.方法 40例需起搏器植入的患者,采用VVI起搏模式,将其随机分为右心室流出道高位间隔部起搏组（RVOTHS组）和右心室心尖部起搏组（RVA组）各20例,观察两组在术中及术后的各项参数以及护理对策.结果 两组患者均顺利完成手术,两组各1例术后发生电极脱位.全部手术无严重并发症出现.RVOTHS组手术曝光时间明显延长,两组比较差异有统计学意义（t=4.036,P＜0.01）.术中两组患者心室的起搏阈值、感知阈值和电极阻抗比较差异均无统计学意义（P＞0.05）,RVOTHS组起搏心电图QRS波宽度较RVA组变窄,但差异无统计学意义（t=1.613,P＞0.05）.结论 右心室流出道高位间隔部起搏是安全和可行的,术后护理重视心电监测及个性化护理,可使并发症的发生率大大降低.

Objective To explore the feasibility and nursing strategy of active-fixation lead in patients with right ventricular outflow tract high septum （ RVOTHS）pacing. Methods Forty patients were divided into two groups randomly and use VVI pacing mode. One group underwent the right ventricular outflow tract high septum（RVOTHS） with the active fixation lead. The other group underwent the right ventricular apex （RVA）pacing with the passive-fixation lead. The parameters and complication after operation of two groups were recorded and compared accordingly. Results Operations went smoothly with few complications in two groups.The active-fixation lead group had one wire dislocation. while the passive-fixation lead group also had one. There was no serious complication during all operations. The exposure time during operation for RVOTHS prolonged obviously （t=4.036,P〈0.01）. The comparative difference of ventricular spacing threshold , feeling threshold and electrode impedance between the two groups during operation had no statistic meaning （P〉0.05）, the pacing electrocardiogram QRS wave width of RVOTHS team was more narrow than that of RVA team, but the difference has no statistical meaning （t = 1. 613, P 〉 0. 05 ）. Conclusions It is safe and feasible to pace in RVOTHS with active electrode. The complication after operation can be well decreased by nursing care and individual nursing.