永久心脏起搏器植入老年患者术后并发症及远期生活质量随访观察

Observation of postoperative complications and long⁃term life quality in elderly patients with permanent cardiac pacemaker implantation by the way of medical follow⁃ups

目的探讨永久心脏起搏器植入老年患者术后并发症、起搏参数及远期心脏功能和生活质量情况。方法选取2015年1月至2019年5月秦皇岛市第一医院收治的行永久心脏起搏器植入的老年患者350例,根据年龄分为高龄组(年龄≥80岁)120例和非高龄组(65岁≤年龄<80岁)230例。比较2组患者围术期并发症发生率、起搏参数及术前和术后36个月时门诊随访时心脏功能指标[左室射血分数(left ventricular ejection fraction,LVEF)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)和左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)],并采用起搏器患者生存质量量表比较2组患者术前和术后36个月时门诊随访时生活质量。结果高龄组患者心肌穿孔、心室颤动发生率高于非高龄组(P<0.05),囊袋感染、切口延迟愈合、囊袋出血或血肿、电极脱位发生率与非高龄组患者比较,差异无统计学意义(P>0.05)。高龄组患者心房起搏阈值、心室起搏阈值高于非高龄组(P<0.05),心房起搏感知、心房阻抗、心室起搏感知、心室阻抗与非高龄组患者比较,差异无统计学意义(P>0.05)。术后36个月时,高龄组与非高龄组患者LVEF较术前升高(P<0.05),LVESD、LVEDD较术前降低(P<0.05),但高龄组患者与非高龄组患者比较,差异无统计学意义(P>0.05)。术后36个月时,高龄组与非高龄组患者生活质量量表躯体功能维度、心理功能维度、社会维度、一般认识维度评分及总分较术前升高(P<0.05),但高龄组患者与非高龄组患者比较,差异无统计学意义(P>0.05)。结论永久心脏起搏器植入有利于有绝对适应证的老年或高龄老年患者。相较于年龄为65~80岁患者,年龄≥80岁患者永久心脏起搏器植入术后心肌穿孔、心室颤动发生风险更高,心房及心室起搏阈值更高,而远期心脏功能和生活质量并无明显变化。

Objective To investigate postoperative complications,pacing parameters,long‑term cardiac function and life quality in elderly patients with permanent cardiac pacemaker implantation.Methods A retrospective study was made on the 350 elderly patients who received permanent pacemaker implantation in the hospital from January 2015 to May 2019,and were divided into the elderly group(n=120,age≥80 years)and the non‑elderly group(n=230,65≤age<80 years),according to age.The rates of perioperative complications,pacing parameters,cardiac function indexes during 36‑month clinical follow‑ups before and after surgery such as left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),and left ventricular end diastolic diameter(LVEDD)were also compared between the patients of the 2 groups.Their life quality were also compared during the 36‑month medical follow‑ups before and after surgery by using the patient life quality scale.Results The rates of myocardial perforation and ventricular fibrillation in the elderly patient group were higher than those in the non‑elderly patient group(P<0.05).There were no statistical differences in the rates of sac infection,delayed incision healing,sac hemorrhage or hematoma,and electrode dislocation,as compared with those of the non‑elderly patient group(P>0.05).The atrial and ventricular pacing thresholds of the elderly patient group were significantly higher than those of the non‑elderly patient group(P<0.05),and there were no significant differences in atrial pacing perception,atrial impedance,ventricular pacing perception and ventricular impedance,when comparisons were made between the groups(P>0.05).36 months after surgery,the LVEF levels in both groups all elevated,as compared with those before surgery(P<0.05),however,the levels of LVESD and LVEDD significantly decreased,as compared with those before surgery(P<0.05).Nevertheless,no statistical significance could be noted,when comparisons were made between the 2 groups(P>0.05).36 months after surgery,the scores of physical function,psychological function,social dimension,general cognition dimension and total scores of QOL in both groups were significantly higher than those before surgery(P<0.05).However,but there was no statistical difference,when the elderly group was compared with the non‑elderly group(P>0.05).Conclusion Permanent pacemaker implantation is of significance for the elderly patients with absolute indications.However,compared with the patient with an age of 65‑80 years,the patients with an age of≥80 years after permanent pacemaker implantation might experience a higher risk of myocardial perforation and ventricular fibrillation,and a higher atrial and ventricular pacing thresholds,but without significant changes in long‑term cardiac function and quality of life.