高龄老年患者置入起搏器的安全性及可行性研究

Safety and feasibility of implanted pacemaker in elderly patients

目的探讨高龄老年患者置入起搏器的安全性和可行性，以及如何预防其并发症的发生。方法对2009年1月至2011年12月共计256例初次置人起搏器患者的临床资料进行回顾性分析，依据年龄不同，分为高龄组（〉75岁，168例）和低龄组（60～74岁，148例）。观察术中、术后起搏器阈值、感知情况，随访术中及术后7d、3个月、半年穿刺并发症及电极脱位、感染等并发症发生情况。结果2组患者性别、糖尿病病史、BMI、心房感知和起搏阈值、右心室感知和起搏阈值等方面差异均无统计学意义（均P〉0．05）。高龄组患者年龄、肺部疾病史患者所占比例均明显高于低龄组老年患者[（84±9）岁比（68±7）岁，63，9％（69／108）比10．1％（15／148）]，差异均有统计学意义（均P〈0．05）。2组发生并发症共计13例，低年龄组6例，高龄组7例。与起搏器置入相关并发症5例，低龄组2例，1例穿刺过程中出现气胸，1例术后7d内出现囊袋血肿；高龄组3例，1例置入术后24h出现气胸，1例置入过程中出现血气胸，1例术后5个月发生起搏器感染。与电极导线相关并发症2例，低龄组和高龄组各I例。与起搏器相关并发症6例，其中低龄组3例，分别为电池提前耗竭2例，起搏器综合征1例；高龄组3例，分别为起搏器移位2例，起搏器感知、起搏功能障碍1例。2组并发症发生情况比较，差异无统计学意义（P〉0．05）。结论高龄患者置人起搏器安全可靠，但同时要了解高龄老年患者的特殊性以及注意围手术期管理。

Objective To evaluate the safety and feasibility of implanted pacemaker in elderly patients. Methods From January 2009 to December 2011, a total of 256 cases of primary implanted pacemaker patients were enrolled. According to the age of the defined standards, 256 patients were divided into 2 groups ： 108 cases in old group and 148 patients in young group. Threshold value, perception perioperative and postoperative, puncture com- plications, electrode dislocation, infection and complications were observed. Results Gender, diabetes, body mass index, atrial pacemaker threshold value and perception, ventricnlar pacemaker threshold value and perception had no significant differences between 2 groups. The age and the patients with lung diseases in old group were obvi- ously more than those in young group[ （84 -4-9 ）old years vs （68 ＋ 7 ）old years, 63.9% （69/108） vs 10.1% （15/ 148）, all P 〈 0.05 ]. The patients with complications in two groups were 13 cases, including 6 cases of young group and 7 cases of old group. The complications associated with implanted pacemaker was 2 cases in young group and 3 cases in old group. The electrode wire related complications included 1 case in each group, and pacemaker related complications were 3 cases in each group; there was no significant differences between two groups （ P 〉 0.05 ）. Conclusion Implanted pacemaker in elderly patients is safe and feasible, but we should understand the characteristics of the elderly patients and pay attention to perioperative and postoperative management.