改良临时起搏在起搏导线拔除中的应用

Application of modified temporary cardiac pacing in lead extraction patients

目的探讨改良临时起搏在起搏导线拔除患者中有效性和安全性。方法选取2012年1月至2016年9月在南京鼓楼医院心血管内科就诊的有起搏系统移除适应证的患者，根据临时起搏路径分为改良临时起搏组及传统临时起搏组。改良临时起搏组从颈静脉通路植入主动导线临时起搏，传统临时起搏组通过股动脉植入被动导线临时起搏。分析比较两组患者在安全性、有效性、经济性及舒适度方面的区别。结果①共入选76例患者，其中传统临时起搏组40例，改良临时起搏组36例；②在安全性方面，改良临时起搏组总并发症5例，传统临时起博组总并发症24例，改良临时起搏组安全性明显优于传统临时起搏组（P〈0.001）；③改良临时起搏组起搏不良、感知不良及导线调整次数均为0，传统临时起搏组共发生起搏不良8次、感知不良10次、导线调整16次，两组相比差异均有统计学意义（P〈0.05）；④改良临时起搏组主观舒适度较传统起搏组高，差异有统计学意义（87.72±5.11对66.98±13.74，P〈0.001）；⑤改良临时起搏组手术材料费用较传统起搏组高[（2 030±146）元对（1 369±224）元，P〈0.001]，但住院总费用低于传统临时起搏组，差异有统计学意义[（87 482±18 617）元对（104 521±36 872）元，P〈0.001]。结论与传统临时起搏相比，改良临时起搏有明显的安全性、有效性及舒适性优势，也有助于降低患者医疗费用。

ObjectiveTo explore the efficiency and safety of modified temporary cardiac pacing in lead extraction patients.MethodsThe patients who were with indications of pacing system removal and received treatment in Nanjing Drum Tower Hospital from Jan. 2012 to Sep. 2016 were chosen and divided into modified temporary pacing group and conventional temporary pacing group in accordance to pathways of temporary pacing. Active electrode temporary pacemaker was implanted from jugular vein pathway in modified temporary pacing group and passive electrode temporary pacemaker was implanted through femoral artery in conventional temporary pacing group. Difference regarding safety, efficiency, economy and well-being of patients in the two groups were analyzed and compared.ResultsIn total 76 patients were enrolled, among whom 40 in conventional temporary pacing group and 36 in modified temporary pacing group. In terms of safety, there were five total complications in modified temporary pacing group and 24 in conventional temporary pacing group. Safety in modified temporary pacing group was obviously better than that in conventional temporary pacing group （P〈0.001） . Pacing dysfunction, poor sensing and number of wire adjustment in modified temporary pacing group were zero. While in conventional temporary pacing group, there were 8 times of pacing dysfunction, 10 times of poor sensing and 16 times of wire adjustment. Comparison of the two groups was statistically different （P〈0.05） . Subjective well-being in modified temporary pacing group was higher than that in conventional pacing group （87.72±5.11 vs. 66.98±13.74, P〈0.001） . Costs of surgical materials in modified temporary pacing group were higher than those in conventional pacing group[￥ （2 030±146） vs. ￥ （1 369±224） , P〈0.001] but general expenses were lower than those in conventional temporary pacing group[￥ （87 482±18 617） vs.￥ （104 521±36 872） , P〈0.001].ConclusionsCompared with conventional temporary pacing, modified temporary pacing is significantly safe, efficient and well-being, and is helpful for reducing medical costs for patients.