心脏外科术后心外膜临时起搏器的应用

The Application of Temporary Pacemaker in Patient After Cardiosurgery

目的 探讨心外膜临时心脏起搏器在心脏外科的临床应用。方法 使用临时起搏器 14 3例患者 ,男 78例 ,女 6 5例 ,年龄 2个月至 81岁。其中风湿性心脏病 4 6例 ,先天性心脏病 87例 ,冠心病 10例。全部病例均在体外循环下行心内直视手术 ,术后安装起搏器。结果 启用心脏起搏器后 ,多数病人药量减少 ,血压回升 ,尿量增加。本组死亡率 13.3% ,康复出院率 86 .7%。停用起搏器复查心电图 ,87例转为窦性心律 ,2 1例Ⅰ°或Ⅱ°AVB ,7例Ⅲ°AVB ,房颤2 5例 ,其它心律 3例。窦性心律者有 18例伴完全或不完性右束支传导阻滞。 80例术后Ⅲ°AVB中有 5 7例转为窦性心律 ,16例Ⅰ°或Ⅱ°AVB ,7例仍为Ⅲ°AVB ,其中 3例改装永久起搏器。未发现重大与起搏器有关的并发症。结论 在心脏外科中 ,临时心脏起搏器是治疗术中出现Ⅲ°AVB有效的措施 ;术中或术后并发药物难以治疗的心律紊乱及心功能不全 ,采用临时心脏起搏器是一种有价值的治疗方法 ,但心内畸形不能矫正及急性心力衰竭不能控制时 ,心脏起搏器有时是不能奏效的。对不能恢复的Ⅲ°AVB应及时改用永久起搏器 。

Objective To study on the clinical application of the temporary pericardial pacemaker in patient after cardiovascular surgery.Methods One hundrand and fortythree patients,including 78 males and 65 females,aged ranged from 2 months to 81 years,46 patients with rheumatic heart disease,87 patients with congenital heart diseaes and 10 patients with coronary heart disease.All of the patients received temporary epicardial pacemaker after cardiovascular surgery. Results After the pacemakers were implanted,most of the patients needed less dosage of vasopressors.The hemodynamics patterns were improved,and urine volume increased.The mortality in this study was 13.3 %,and 86.7 %of the patients recovered and discharged.After removal of pacemaker ,the ECG in 87 patients were converted to normal sinus rhythm,while 21 patients were Ⅰ °or Ⅱ °AVB,7 patients Ⅲ °AVB,25 patients atrial fibrillation,and 3 patients in other rhythm.In patients 57 of the 80 postoperative patients suffering from Ⅲ ° AVB were converted to normal sinus rhythm,16 patientsⅠ °orⅡ °AVB,7 patients still unchanged,while 3 patients changed to implant permanent pacemakers.No serious complications related to pacemakers were found.Conclusion The implantation of temporary pacemaker is an effective measure for treatment of patients occured Ⅲ °AVB during cardiosurgery.It is also a valuable treatment for patients suffering from incurable arrhythmia as well as insufficiency of cardiac function,when drugs are uneffective.But in patients with intracardial malformation and uncontrolled acute cardial failure the pacemaker may not be effective.Permanent pacemaker should be implanted promptly in the case suffering from Ⅲ ° AVB.