CAJ | 학술논문

目的探讨心脏再同步治疗(CRT)植入术中、术后膈神经刺激发生情况及处理方法.方法心力衰竭患者79例,其中男性45例,女性34例,年龄35～86岁,接受CRT/CRT-D植入术.术后平均随访24个月,观察膈神经刺激发生情况,同时给予相应的处理措施.结果 78例患者成功植入,成功率为98.7%.植入术中、术后膈神经刺激发生率为12.8%.后静脉、侧后静脉是其好发部位,身材偏矮小及心脏增大的患者CRT植入中出现膈神经刺激危险性增高.调整电极导线位置、输出电压和脉宽以及改变极性等方法,可以有效消除膈神经刺激.结论膈神经刺激是CRT/CRT-D植入术中、术后的常见并发症;严格做好术中预防、术后随访,及时采取有效的干预手段,以减少或避免膈神经刺激的发生.
목적 탐토심장재동보치료(CRT)식입술중、술후격신경자격발생정황급처리방법.방법 심력쇠갈환자79례,기중남성45례,녀성34례,년령35～86세,접수CRT/CRT-D식입술.술후평균수방24개월,관찰격신경자격발생정황,동시급여상응적처리조시.결과 78례환자성공식입,성공솔위98.7%.식입술중、술후격신경자격발생솔위12.8%.후정맥、측후정맥시기호발부위,신재편왜소급심장증대적환자CRT식입중출현격신경자격위험성증고.조정전겁도선위치、수출전압화맥관이급개변겁성등방법,가이유효소제격신경자격.결론 격신경자격시CRT/CRT-D식입술중、술후적상견병발증;엄격주호술중예방、술후수방,급시채취유효적간예수단,이감소혹피면격신경자격적발생.
Objective To analyze the phrenic nerve stimulation and the appropriate treatment during and after CRT/CRT-D implantation. Methods Seventy-nine patients (45 men and 34 women, aged 35 ～ 86 years) received CRT/CRT-D implantation. The patients were followed up for average 24 months. The phrenic nerve stimulations was analyzed and the corresponding treatments were taken. Results Seventy-eight patients received successful implantation(98. 7% ). The incidence rates of the phrenic nerve stimulation is 12. 8% during and after the implantation. Posterior veins and posterior lateral veins are predilection sites. The risk increased in the patients with short stature and enlarged heart. Phrenic nerve stumilation can be eliminated by adjusting the electrode position, output voltage pulse, width and changing the polarity. Nobody needs another operation because of the phrenic nerve stimulation. Conclusions Phrenic nerve stimulation is a common complication of CRT/CRT-D implantation operation. Doctors should take great attention to prevent this complication during the implanting procedure and follow-up.