儿童永久起搏器植入术后手臂固定装置的设计及应用

Design and application of arm fixation device for pediatric permanent pacemaker post-operative implantation

目的设计儿童心内膜起搏器植入术后手臂固定装置,并评价其对起搏电极预留长度的保护效果。方法制作儿童手臂固定装置,材料包括超宽弹力带和可调节扣,由身体侧和手臂侧2部分组成。选取2019年1月—2021年12月因缓慢性心律失常,接受心内膜永久起搏器植入的婴幼儿患者46例为研究组;采用历史对照方法,选取2015年1月—2018年12月植入心内膜永久起搏器,未应用手臂固定装置的婴幼儿患者40例作为对照组。观察两组患儿术后6个月电极预留长度的变化;并根据术后满意度量表评估家庭护理倦怠程度、护理难度及对患儿患侧肢体活动关注程度。根据Carroll上肢功能评定量表,评价并比较研究组患儿术后6个月时上肢功能,同时测量其双上肢臂围。对于计量资料的组间比较,符合正态分布的采用独立样本t检验、不符合正态分布的采用秩和检验;计数资料采用χ^(2)检验。结果术后6个月的电极预留长度,研究组为(41.28±7.73)mm、对照组为(29.41±14.28)mm,差异有统计学意义(t=-3.71,P<0.01)。术后5 d及6个月家庭护理倦怠程度评分比较,两组差异无统计学意义(P均>0.05)。术后6个月研究组家长关注患儿患侧肢体活动的比例为6.5%(3/46)、对照组为87.5%(35/40),差异有统计学意义(χ^(2)=56.8、P<0.05);研究组患儿术后6个月双侧上肢臂围分别为(13.6±4.3)、(14.2±3.9)cm,差异无统计学意义(t=0.70,P>0.05);研究组去除手臂固定装置后,Carroll上肢功能评分为(94.0±3.4)分,功能正常。结论手臂固定装置对起搏电极预留长度具有保护作用,并且降低家长看护的难度。

Objective To design a post-operative implantation arm fixation device for pediatric endocardial pacemaker implantation procedures and evaluate its protective effect on the pacing electrode reserve length.Methods A pediatric arm fixation device was created,consisting of two parts,including an ultra-wide elastic band and an adjustable fastener on the body and arm sides.A total of 46 infant and toddler patients who underwent permanent endocardial pacemaker implantation due to bradycardia from January 2019 to December 2021 were selected as the study group.Using a historical control method,40 infant and toddler patients who underwent endocardial pacemaker implantation from January 2015 to December 2018 without the use of an arm fixation D0I:10.19450/j.cnki.jcrh.2023.05.010 device were selected as the control group.Changes in electrode reserve length at 6 months post-operation were observed in both groups.Additionally,the study assessed home care fatigue,nursing difficulty,and attention to the affected limb's activity in the children by utilizing a postoperative satisfaction scale.Upper limb function at 6 months post-operation was evaluated and compared using the Carroll Upper Extremity Evaluation Scale,and measurements of bilateral arm circumferences were taken.For intergroup comparisons of quantitative data,the independent sample t-test was used for data with a normal distribution,and the rank sum test was used for data without a normal distribution.Theχ^(2) test was employed for categorical data.Results At 6 months post-operation,the electrode reserve length in the study group was(41.28±7.73)mm,while it was(29.41±14.28)mm in the control group,and the difference was statistically significant(t=-3.71,P<0.01).There was no statistically significant difference in home care fatigue scores at 5 days and 6 months post-operation between the two groups(all P>0.05).The proportion of parents in the study group who paid attention to the affected limb's activity in the child at 6 months post-operation was 6.5%(3/46),while it was 87.5%(35/40)in the control group,with a statistically significant difference(χ^(2)=56.8,P<0.05).At 6 months post-operation,the study group's children had bilateral upper limb circumferences of(13.6±4.3)cm and(14.2±3.9)cm,respectively,with no statistically significant difference(t=0.70,P>0.05).After removing the arm fixation device in the study group,the Carroll Upper Extremity Evaluation Score was(94.0±3.4),indicating normal function.Conclusions The arm fixation device provides protection for the pacing electrode reserve length and reduces the difficulty of parental care.