磁共振兼容心脏起搏器的单中心植入现状分析

The current status of magnetic resonance imaging compatible pacemaker implantation in a single center

目的 研究单中心磁共振（MRI）兼容心脏起搏器的植入现状.方法 入选2016年9月至12月期间在复旦大学附属中山医院心内科新植入心脏起搏器的患者,采用问卷形式对272例患者在心脏起搏器植入术前进行MRI兼容心脏起搏器的选择意愿调查并分析原因,同时收集本中心MRI兼容心脏起搏器植入数量、植入后行MRI检查次数、部位及检查前后起搏器参数对比.结果 ①272例患者中96例患者（35.3%）选择MRI兼容心脏起搏器（包括脉冲发生器和导线）,132例患者（48.5%）选择普通心脏起搏器,44例患者（16.2%）选择MRI兼容起搏导线＋非MRI兼容普通脉冲发生器.272例中有176例患者（64.7%）在植入心脏起搏器前未做过MRI检查;②96例选择MRI兼容心脏起搏器的患者中有52例（54.2%）这样选择MRI兼容心脏起搏器的原因在于既往做过MRI检查;③272例患者中大部分患者对MRI兼容心脏起搏器最关注的是安全和价格（分别为132例和92例,占48.5%和33.8%）;而176例未选择MRI兼容心脏起搏器的原因是认为以后做MRI检查的可能性很小及认为价格相对昂贵（分别为80例和60例,占45.5%和34.1%）;④272例患者中122例（44.9%）认为MRI兼容心脏起搏器价格比普通心脏起搏器价格高2万元以内可以接受;⑤与选择MRI兼容心脏起搏器的患者相比,44例选择植入MRI兼容起搏导线＋非MRI兼容普通脉冲发生器的患者相对年轻[（72.6±12.6）岁对（63.2±8.0）岁,P=0.027],医保比例低（70.8%对36.1%,P=0.048）,既往做过MRI检查的比例低（50.0%对16.9%,P=0.029）,其中40例患者（90.9%）这样选择的原因是以后更换时可以多一种选择;⑥对本中心已植入的225例MRI兼容心脏起搏器患者,中位随访期7.2个月,共行MRI检查13例（5.8%）,检查前后测定起搏器参数差异无统计学意义（P〉0.05）.结论 本中心实际选择MRI兼容起搏器和术后真正实施MRI检查的患者比例与国外相比仍有差距.价格可能是是否选择MRI兼容起搏器的主要原因.

Objective To study the current status of magnetic resonance imaging（MRI） compatible pacemakers in our center.Methods Two hundred and seventy two patients in Zhongshan Hospital,Fudan University from September,2016 to December,2016 were recruited and asked to fill a questionnaire about MRI compatible pacemakers before implantation.The actual amount of MRI compatible pacemakers implanted in our center,the times of MRI scan after implantation and the parameters of the pacemakers before and after MRI scan were also collected and studied.Results ① Of all the 272 patients,96 （35.3%） of them chose to implant an MRI compatible pacemaker,132 （48.5%） chose a conventional pacemaker and 44 （16.2%） chose MRI compatible leads and a conventional non-MRI compatible generator.One hundred and seventy-six （64.7%） of the 272 patients did not perform MRI scan before implantation.② Fifty-two （54.2%） of the 96 patients chose an MRI compatible pacemaker since they had received MRI scan before.③ One hundred and thirty-two patients （of all the 272） concerned about the safety and 92 （of all the 272） concerned about the price of MRI compatible pacemakers （48.5% and 33.8%,respectively）.The reason of the 176 patients who did not choose an MRI compatible pacemaker was likely to be the less possibility of their MRI scan they thought in future and the unaffordable price [80 cases （45.5%） and 60 cases （34.1%）,respectively].④ One hundred and twenty-two of the 272 patients （44.9%） thought the reasonable price of the MRI compatible pacemakers was less than 20 000 RMB higher than the conventional ones.⑤ As compared to the patients choosing an MRI compatible pacemaker,the one who chose MRI compatible leads and a conventional non-MRI compatible generator （n=44） were relatively younger [（72.6±12.6）years vs.（63.2±8.0） years,P=0.027],and the proportion of having insurance（70.8% vs.36.1%,P=0.048） and previous MRI scan were significantly lower（50.0% vs.16.9%,P=0.029）.And 40 of them （90.9%） made this choice for they would have one more chance of choosing an MRI compatible generator when replacing the generator in future.⑥ Of all the 225 cases implanted an MRI compatible pacemaker in our center,within a median follow-up of 7.2 months,13 of them （5.8%） underwent MRI scan after implantation and the parameters of the pacemaker were not significantly different before and after the scan（P〉0.05）.Conclusion The actual proportion of MRI compatible pacemaker implantation and the demand of MRI scan after implantation in our center were lower than the studies abroad.The relatively high price might be a possible reason.