心室主动固定起搏导线植入过程的优化流程与传统方法的比较分析

Comparison and analysis of the optimization process of ventricular active fixation pacemaker lead implantation with traditional methods

目的 根据心肌兴奋性预判对起搏器植入术流程优化,并比较优化流程与传统方法的效果。方法 对32例患者(观察组)起搏器植入过程中增加主动固定螺旋电极导线拧入前阈值测试,判断心肌兴奋性,并延长阈值下降观察时间30 min,观察调整导线位置次数、X线曝光时间及剂量等参数与前期310例(对照组)传统方法(观察5~10 min,如不满意则更换位置)的差异。结果 两组共78.1%的患者阈值恢复时间在10 min以内。21.9%患者在10 min未降至要求范围内,其中对照组68例更换了起搏位置,优化组7例则继续观察至30 min。最终对照组4例(1%)更换多个位置仍达不到阈值要求范围,故放弃更换位置,最终观察时间超过20 min,最后在起搏器与导线连接前测量阈值降至1V以下。与对照组比较,观察组X线曝光剂量[(227.7±38.5) mGay vs (440.8±51.5) mGay],手术时间[(51.8±8.4)min vs (61.8±7.6)min],电极更换部位次数(1.0±0.2 vs 2.1±1.2)均明显减少或缩短(P均<0.001)。结论 优化流程可减少不必要的位置调整,减少X线的暴露量及手术时间。

Objective To optimize the pacemaker implantation process according to the myocardial excitability prediction,and compare the effect of the optimized process with the traditional method.Methods During the pacemaker implantation in 32patients(observation group),the threshold test before screwing in the active fixed spiral electrode lead was added to judge the excitability of the myocardium,and the observation time of lowering the threshold was extended for 30minutes.The differences between the number of times of adjusting the lead position,the X-ray exposure time and the dose and other parameters of the previous 310patients(control group)and the tra-ditional method(observation for 5-10minutes,if not satisfied,change the position)were observed.Results The threshold recovery time of 78.1%of patients in both groups was within 10minutes.21.9%of patients did not fall within the required range within 10minutes,of which 68patients in the control group changed the pacing position,and 7patients in the optimization group continued to observe the value for 30minutes.In the final control group,4 cases(1%)still failed to reach the threshold range after replacing multiple positions,so they abandoned the replacement position,and the final observation time was more than 20minutes.Finally,the measured threshold fell below 1Vbefore the pacemaker was connected to the lead.Compared with the control group,the X-ray exposure dose[(227.7±38.5)mGay vs(440.8±51.5)mGay],the operation time[(51.8±8.4)min vs(61.8±7.6)min],and the number of electrode replace-ment sites(1.0±0.2vs 2.1±1.2)in the observation group were significantly reduced or shortened(all P<0.001).Conclusion Optimizing the procedure can reduce the unnecessary position adjustment,the exposure of X-ray and the operation time.