埋藏式心脏转复除颤器植入术中除颤阈值测试的管理

Management of defibrillation threshold test in the implantation of implantable cardioverter defibrillator

目的探讨埋藏式心脏转复除颤器(ICD)植入术中除颤阈值(DFT)测试过程中的监护与管理要点,降低测试过程中的并发症发生率。方法回顾性分析50例植入ICD患者术中DFT测试与管理的过程,观察在规范化监护和管理下并发症的发生率。结果 50例患者植入手术过程顺利。1例患者在测试中首次除颤未成功,第2次予最大能量除颤成功;1例在行DFT测试后出现持续低血压和低血氧状态,通过及时应用升压药和增大给氧流量后恢复;1例患者诱发室颤未成功,放弃DFT测试,给予经验性能量设置。术后所有患者生命体征平稳,无手术相关重大并发症发生。结论 ICD除颤阈值测试的过程中,有出现持续低血压、低血氧和除颤阈值偏高等情况的可能,全面、有效的监护管理能显著降低DFT测试中的风险。

Objective To explore the guardianship and management points of defibrillation threshold test（DFT） in the implantation of implantable cardioverter defibrillator （ICD）. Methods Test and management procedures of DFT in 50 patients with ICD implantation were analyzed retro- spectively. Incidence rate of complications was observed under the standardized guardianship and management. Results All the patients had successful operations. One patient failed in the first de- fibrillation, and then had successful defibrillation with a maximum energy in second time. One patient had persistent hypotension and hypoxemia after DFT, which were corrected after application of presmr agent and increasing of oxygen flow. One patient received empirical energy setting instead of DET because of ventricular fibrillation. After the operation, all the patients＇vital signs were stable, and no one had severe operation- related complications, Conclusion Persistent hypotension, hypoxemia and high defibrillation threshold may occur in process of DFT, and comprehensive and ef- fective management and guardianship can significantly reduce the risks in DFT.