永久心脏起搏器更换87例临床分析

Clinical analysis of 87 cases of permanent cardiac pacemaker replacement

目的分析永久心脏起搏器更换的原因以及围术期并发症防治策略。方法回顾性分析首都医科大学附属北京安贞医院心内科十五病房2008年6月至2018年7月行永久心脏起搏器更换手术的87例患者的临床资料。心律失常诊断:病态窦房结综合征48例,房室传导阻滞21例,心房颤动伴有长间期18例。结果单腔起搏器更换11例(12.6%),双腔起搏器更换76例(87.4%)。起搏器电池平均使用时间(96±13)个月(72～168个月)。更换原因为起搏器电池自然耗竭86例(98.9%),电池提前耗竭1例(1.1%)。电极导线除1例达到更换年限外,其余均保留原电极。术中18例(20. 7%)起搏器依赖患者为降低手术风险,预置临时起搏保护。更换起搏器时测试心室、心房起搏阈值[(1. 1±0. 3)、(1. 2±0. 2) V]与首次植入时心室、心房阈值[(0. 5±0.2)、(0.7±0.2)V]比较明显增加(P <0.01)。更换时心室、心房电极阻抗[(481±102)、(530±113)Ω],R波/P波振幅[(10.0±1.1)、(2.9±1.3)mV]与首次植入时[(470±98)、(521±100)Ω,(9.8±1.4)、(2.7±1.7)mV]比较,差异均无统计学意义(均P>0.05)。结论心脏起搏器更换的主要原因是电池自然耗竭;起搏器更换时大多数参数提示心房和心室电极可以继续使用。起搏器依赖患者在更换时需预置临时起搏器保护心脏。规范治疗策略可以将围术期并发症降到最低。

Objective To analyze the reasons of permanent cardiac pacemaker replacement and the treatment strategies for relevant complications. Methods Clinical data of 87 patients who had cardiac pacemaker replacement in Beijing Anzhen Hospital, Capital Medical University from June 2008 to July 2018 were retrospectively analyzed. There were 48 cases of sick sinus syndrome, 21 cases of atrioventricular heart-block and 18 cases of atrial fibrillation with long interval. Results A total of 87 pacemaker pulse generators were replaced. Single chamber pacemakers were replaced in 11 cases(12.6%). Dual chamber pacemakers were replaced in 76 cases(87.4%). Average service life of batteries was (96±13)months(72-168 months). Expected life of battery was achieved in 86 cases(98.9%). Pacemaker lead was replaced in 1 case due to the service life. Temporary pacing was used during operation in 18 patients(20.7%) with pacemaker dependence. Before replacement, ventricular and atrial pacing thresholds[(1.1±0.3), (1.2±0.2)V] were significantly higher than the initial thresholds[(0.5±0.2),(0.7±0.2)V](P<0.01). There were no significant differences of electrode impedance and R/P wave amplitude between pacemaker replacement[(481±102),(530±113)Ω;(10.0±1.1),(2.9±1.3)mV] and initial implantation[(470±98),(521±100)Ω;(9.8±1.4),(2.7±1.7)mV](P>0.05). Conclusions The primary reason of pacemaker replacement is battery depletion. Most leads function well. Patients with pacemaker dependence need temporary pacing during operation to protect the heart. Appropriate strategies can minimize perioperative complication.