中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
4期
363-368
,共6页
导管插入术,外周%心脏起搏,人工
導管插入術,外週%心髒起搏,人工
도관삽입술,외주%심장기박,인공
Catheterization,peripheral%Cardiac pacing,artificial
目的 研究旨在分析激光导管拔除心脏起搏除颤导线的安全性和有效性.方法回顾性分析美国明尼苏达大学退役军人医疗中心自2008年3月至2009年12月间用激光导管拔除起搏除颤导线的连续16例患者,通过对患者的一般临床状况、基础疾病、心功能状态、起搏除颤导线拔除原因、导线状况及并发症等进行分析,了解激光拔除起搏除颤导线的方法、步骤、安全性和有效性,并总结手术经验及减少并发症的方法.结果 16例患者均为男性,年龄54～82(67.4 ±9.1)岁,多数患者均有严重的心脏疾病,左室射血分数为20%～60%(36.4±13.4)%.16例中,9例为拔除导线的Ⅰ类适应证,7例患者为Ⅱ类适应证.导线置入的时间为3～251(73.9±62.9)个月,其中时间最长者达251个月.共拔除导线31根,其中25根使用激光导管.所有患者均成功拔除导线,没有并发症.其中1例患者心房导线被拉断,经股静脉送入抓取工具后将导线残段经股静脉拉出,没有并发症发生;另1例患者成功拔除了3根导线,但在升级BiV-埋藏式心脏自动复律除颤器手术时导致冠状窦夹层及心包积液,未进行心包穿刺而稳定出院.结论初步研究资料表明,应用激光导管等综合方法和工具经静脉拔除心脏起搏除颤导线是安全、有效的.
目的 研究旨在分析激光導管拔除心髒起搏除顫導線的安全性和有效性.方法迴顧性分析美國明尼囌達大學退役軍人醫療中心自2008年3月至2009年12月間用激光導管拔除起搏除顫導線的連續16例患者,通過對患者的一般臨床狀況、基礎疾病、心功能狀態、起搏除顫導線拔除原因、導線狀況及併髮癥等進行分析,瞭解激光拔除起搏除顫導線的方法、步驟、安全性和有效性,併總結手術經驗及減少併髮癥的方法.結果 16例患者均為男性,年齡54～82(67.4 ±9.1)歲,多數患者均有嚴重的心髒疾病,左室射血分數為20%～60%(36.4±13.4)%.16例中,9例為拔除導線的Ⅰ類適應證,7例患者為Ⅱ類適應證.導線置入的時間為3～251(73.9±62.9)箇月,其中時間最長者達251箇月.共拔除導線31根,其中25根使用激光導管.所有患者均成功拔除導線,沒有併髮癥.其中1例患者心房導線被拉斷,經股靜脈送入抓取工具後將導線殘段經股靜脈拉齣,沒有併髮癥髮生;另1例患者成功拔除瞭3根導線,但在升級BiV-埋藏式心髒自動複律除顫器手術時導緻冠狀竇夾層及心包積液,未進行心包穿刺而穩定齣院.結論初步研究資料錶明,應用激光導管等綜閤方法和工具經靜脈拔除心髒起搏除顫導線是安全、有效的.
목적 연구지재분석격광도관발제심장기박제전도선적안전성화유효성.방법회고성분석미국명니소체대학퇴역군인의료중심자2008년3월지2009년12월간용격광도관발제기박제전도선적련속16례환자,통과대환자적일반림상상황、기출질병、심공능상태、기박제전도선발제원인、도선상황급병발증등진행분석,료해격광발제기박제전도선적방법、보취、안전성화유효성,병총결수술경험급감소병발증적방법.결과 16례환자균위남성,년령54～82(67.4 ±9.1)세,다수환자균유엄중적심장질병,좌실사혈분수위20%～60%(36.4±13.4)%.16례중,9례위발제도선적Ⅰ류괄응증,7례환자위Ⅱ류괄응증.도선치입적시간위3～251(73.9±62.9)개월,기중시간최장자체251개월.공발제도선31근,기중25근사용격광도관.소유환자균성공발제도선,몰유병발증.기중1례환자심방도선피랍단,경고정맥송입조취공구후장도선잔단경고정맥랍출,몰유병발증발생;령1례환자성공발제료3근도선,단재승급BiV-매장식심장자동복률제전기수술시도치관상두협층급심포적액,미진행심포천자이은정출원.결론초보연구자료표명,응용격광도관등종합방법화공구경정맥발제심장기박제전도선시안전、유효적.
Objective The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction. Methods Consecutive lead extraction in 16 patients using the excimer laser sheath from Veterans Administration Medical Center, University of Minnesota between March 2008 and December 2009 were analyzed retrospectively. The clinical characteristics including basic disease, cardiac function, indication and reason for lead removal, lead characteristic, and complication were summarized. Results Thirty one leads ( laser sheaths were used in 25 leads) in 16 patients [mean age (67.4 ±9. 1 )years, range 54-82 years] were extracted. All leads were extracted successfully without complication.Most patients had severe heart diseases with left ventricular ejection fraction of 20% -60% (mean 36. 4% ±13.4% ). Mean implant time was (73.9 ±62. 9)months (range 3 -251 months). Nine patients had Class Ⅰ indications for lead extraction, 7 patients for Class Ⅱ indications. Atrial lead fractured in one patient during lead extraction, the remaining part of the lead was taken out from femoral vein by a snare-catheter apparatus. Another patient developed CS dissection and small pericardium perfusion during LV lead implantation (upgrade to BiV-ICD ) post successful lead extraction and patient discharged without complication. Conclusion Our single center experience suggests that Excimer Laser Sheath Lead Removal System is safe and effective in extracting pacemaker and ICD leads.
