三度房室传导阻滞患者心脏起搏的临床分析

Clinical analysis on cardiac pacing in patients with third degree atrioventricular block

目的探讨三度房室传导阻滞患者心脏起搏的临床应用。方法回顾分析我科住院的心电图示三度房室传导阻滞患者心脏起搏的应用情况。结果 36例三度房室传导阻滞患者中,31例在入院后即刻置入临时起搏导管,1例于入院4 d后置入,4例择期行永久起搏器安装术。1例高钾血症临时起搏3d后拔除,3例重症心肌炎临时起搏5~7 d后拔除,2例急性下壁心肌梗死在临时起搏3 d后死于心衰。26例在临时起搏1~16 d后,采取穿刺左锁骨下静脉或切开头静脉的方法植入单腔或双腔永久起搏器,术后立即拔除临时起搏电极。全部患者术中均无并发症发生,其中1例永久起搏器安装术后第二天死于急性脑梗死。结论三度房室传导阻滞患者一般需要急诊临时心脏起搏,后根据病因及心率恢复情况行永久起搏器安装术。

Objective To investigate the safety and effectiveness of cardiac pacing in treating patients with third degree atrioventricular block( Ⅲ° AVB). Methods Retrospective analysis was carried out on the application of cardiac pacing in inpatients in our department showed Ⅲ°AVB by ECG. Results Among the enrolled 36 patients with Ⅲ°AVB,31 cases were implanted with temporary pacing catheters the moment on admission,one case was implanted four days after admission,and another four underwent elective permanent pacemaker implantation. The temporary pacing catheter was pulled out three days after implantation in one case with hyperpotassemia,and 5- 7 days after implantation in three cases for severe myocarditis while two cases with inferior wall acute myocardial infarction died of heart failure three days after temporary cardiac pacing. Twenty-six patients were implanted with single-chamber or dual-chamber permanent pacemakers by means of puncturing left subclavian vein or cutting cephalic vein open,1- 16 days after temporary cardiac pacing,and the temporary pacing electrodes were removed immediately after the operation. No complication occurred during operation. One case died of acute cerebral infarction two days after permanent pacemaker implantation. Conclusion The patient with Ⅲ° AVB usually needs emergency treatment of temporary cardiac pacing,and is given permanent pacemaker implantation according to the cause of disease and the conditions of heart rate recovery.