起搏器更换相关并发症的单中心分析

Complications associated with device replacement in China： a single center experience

目的回顾性分析阜外心血管病医院起搏器更换手术相关并发症的发生情况。方法分析2008年6月至2011年6月期间在阜外心血管病医院接受起搏器更换的714例患者。术后3、6、12个月时工作人员通过常规门诊随访或电话随访的方式进行随访，之后改为每年1次，并以电话随访方式进行非定期随访。通过术后定期门诊随访或电话随访了解患者并发症发生情况，平均随访（19．5±9．7）个月。所有与手术相关的并发症均纳人本次研究。结果随访期间共22例（3．1％）患者出现手术相关的并发症其中，13例（1．8％）出现次要并发症，包括4例起搏器囊袋血肿，2例起搏器移位，6例伤L]愈合4j良和1例局限性气胸；9例（1．3％）出现主要并发症，包括3例起搏导线脱位，3例严重的囊袋血肿，起搏器囊袋调整1例和2例严重的感染。9例主要并发症患者均接受了再次手术。接受起搏器导线相关操作的患者并发症发生率有增高的趋势。服用抗凝和抗血小板药物并不增加患者术后并发症的风险。结论尽管由经验丰富的医师进行操作能够降低起搏器更换的并发症发生率，但手术操作仍存在不能忽略的风险。我国植入型心律转复除颤器和心脏再同步治疗起搏器的更换数量较少，对此类起搏器更换术后的并发症情况仍需要进一步观察。

Objective To evaluate the complication rates associated with device replacement in Fuwai hospital. Methods Seven hundred and fourteen patients underwent device replacement in Fuwai hospital from June 1 - 2008 to June 1 - 2011 were involved. Patients were conventionally received an out-patient follow-up in 3,6 and 12 months, after that, once a year. The mean follow-up time was （ 19.5 ±9. 7） months. Complications associated with operation were counted. Results Complications occurred in a total of 22 patients（3. 1% ）. There were 13 minor complications （ 1.8 % ） includeded ： hematoma （ n = 4 ）, device migration （ n = 2 ）, incisional dehis- cence （ n = 6） and limited pneumothorax （ n = 1 ）. There were 9 major complications （ 1.3 % ） includeded ：lead dis- location（ n= 3 ）,hematoma（ n = 3 ）, pocket revision （n = 1 ）and infections requiring system removal in two pa- tients. There was no significant difference in the complication rate between patients with and without leads oper- ation. Anticoagulation therapy and anti-platelet therapy did not increase the risk of complications. Conclusions Device replacements performed in a center with enough experience demonstrated a low but not negligible risk of complications. The complications related to implantable cardioverter defibrillator（ICD） and cardiac resynchroni- zation therapy（CRTP/D） replacement need further invetigation.