高龄患者心血管植入型电子器械感染后移除的临床效果及安全性分析

Clinical application research of transvenous lead extraction for cardiovascular implantable electronic devices related infection in patients over 75 years old

目的分析和评价≥75岁患者心血管植入型电子器械(CIED)感染后经静脉起搏系统移除术的有效性及安全性。方法回顾性分析南京鼓楼医院2013年1月至2019年10月行经静脉起搏系统移除术的患者资料,根据年龄分为≥75岁组和<75岁组。对比两组患者的性别、伴随疾病、植入设备类型、导线根数及种类、麻醉方法、移除方式、并发症发生率及完全移除率等特征。结果研究入选316例患者,其中≥75岁组115例(男79例),<75岁组201例(男151例);<75岁组移除的除颤装置更多(10.9%对4.3%,P=0.044)。①两组患者在麻醉方式、手术时间、多根导线患者的比例、导线植入时间及拔除方式均差异无统计学意义。②安全性评估:两组患者均无住院期间死亡事件发生,≥75岁组有7例(6.1%,7/115)出现轻度并发症,无严重并发症发生;<75岁组有10例(5.0%,10/201)出现轻度并发症,1例(0.5%,1/201)出现严重并发症。③有效性评估:≥75岁组中111例(96.5%,111/115)患者起搏系统经静脉完全移除,4例(3.5%,4/115)取得临床成功,无移除失败事件;<75岁组中191例(95.0%,191/201)患者起搏系统完全移除,9例(4.5%,9/201)取得临床成功,1例(0.5%,1/201)经静脉移除失败。安全性及有效性评估差异无统计学意义。结论对于CIED感染的≥75岁患者,行经静脉起搏系统移除术是可行的,安全性和有效性并不亚于<75岁人群。

Objective To explore the safety and efficiency of transvenous lead extraction of cardiovascular implantable electronic devices(CIED)related infection in elderly patients.Methods A retrospective review was conducted on the patients with CIED related infection who underwent transvenous lead extraction from January 2013 to October 2019 in Nanjing Drum Tower Hospital.These patients compromised≥75 years old group and<75 years old group.The differences in gender,comorbidities,type of implanted devices,number and type of leads,anesthesia method,extraction methods,incidence of complications and complete removal rate between the two groups were analyzed and compared.Results A total of 316 patients were enrolled.Amond them,115 patients were in≥75 years old group,79 cases male.And 201 patients were under 75 years old,151 cases male.There were more defibrillation device in the<75 years old group(10.9%vs.4.3%,P=0.044).Safety evaluation:there were no death events during hospitalization in both groups.Seven cases(6.1%,7/115)of≥75 years old group had mild complications,no serious complications.Ten cases(5.0%,10/201)of<75 years old group had mild complications,and 1 case had serious complications.Effectiveness evaluation:111 patients(96.5%,111/115)in≥75 years old group had complete removal of pacing system.Four patients(3.5%,4/115)achieved clinical success without removal failure.And 191 patients(95.0%,191/201)in<75 years old group had complete removal of pacing system,9 patients(4.5%,9/201)had clinical success,and 1 cases(0.5%,1/201)failed to remove pacing system.There was no significant difference in the evaluation of safety and effectiveness.Conclusion For the patients≥75 years old with CIED infection,transvenous lead extraction is an effective and safe way.