抗栓药物治疗时代心脏永久起搏器植入术后的囊袋并发症分析

Complications analysis after the operation of implanting permanent pacemaker in the antithrombotic therapy era

目的:了解目前的强化抗栓治疗策略对心脏永久起搏器植入术后囊袋血肿发生率的影响。方法:对2002-03-2012-12期间,在我院首次植入或更换的永久心脏起搏器患者的植入以及随访资料进行回顾分析。结果:共有632例患者在我院植入或更换永久心脏起搏器,共有29例患者出现起搏器囊袋并发症。443例(70.09%)患者使用抗栓药物治疗,其中发生早期囊袋并发症18例(4.74%),发生晚期囊袋并发症6例(1.81%)。189例(29.91%)患者未使用抗栓治疗药物,其中发生早期囊袋并发症3例(1.59%),发生晚期囊袋并发症2例(1.06%)。与未使用抗栓治疗药物相比,使用抗栓治疗药物明显增加早期囊袋血肿并发症的发生率(4.74%:1.59%,P<0.05)。晚期囊袋并发症主要见于高龄、糖尿病以及低体重患者。结论:目前的强化抗栓治疗策略明显增加起搏器植入早期囊袋血肿并发症的发生率。

Objective：To identify the influence of intensive antithrombotic therapy on the rate of pocket hema- toma complications. Method： From January 1, 2002 to December 31, 2012, cardiac permanent pacemaker were first implanted or replaced in 632 patients, all patient＇s clinical manifestations, follow--up data were analyzed retro- spectively. Result：A document pocket-related complication occurred in 29 of 632 patients （4.59%）. The 443 pa- tients （70.09 %） received anticoagulation and/or anti-platelet therapy. Among them, 18 cases （4.74 %） had early complications and 6 cases （1.81%）had late complications. The 189 patients （29.91%） did not receive anticoagu- lation and/or anti-platelet therapy. Among them, 3 cases （1.59%） had early complications and 2 cases （1. 06%） had late complications. Compared with patients without antithromhotic therapy, antithrombotic therapy was asso ciated with an increase of the incidence of early pocket hematoma after pacemaker implantation（4.74~ ： 1.59~, P%0.05）. Late complications occurred mostly in old-age patients, diabetes mellitus patients and patients with low body weight. Conclusion：The present intensive antithrombotic therapy strategy is associated with an increase of the incidence of early pocket hematoma significantly.