CAJ | 학술논문

目的：探讨术前进行窦房结功能测定对非心脏手术老年患者安置临时起搏器的筛选价值，并分析麻醉方式、置入路径等对临时起搏的影响及并发症发生风险的差异。方法纳入2009年10月~2012年10月河北大学附属医院外科住院60岁以上老年患者112例，均为非心脏手术患者，术前心电图示窦性心动过缓、阿托品试验阳性，故均置入临时起搏器，而后再经食管心房调搏（TEAP）判断窦房结功能，主要终点为起搏器在术中是否工作，次要终点为患者的一般资料、麻醉方式、置入途径、并发症等进行总结分析。结果①入组患者中食管调搏检查阳性者48例（42.86%）；②食管调搏阳性患者术中术后起搏比例高于食管调搏阴性患者（70.83%vs.10.94%，P＜0.05）；③所有患者按照麻醉方式分类后发现不同麻醉方式下术中术后起搏比例无统计学意义（全身麻醉起搏vs.连续硬膜外麻醉起搏vs.局部浸润麻醉：35.42%vs.31.25%vs.28.57%，P＞0.05）；④不同临时起搏器置入方式的并发症发生率无统计学差异，未发生假性动脉瘤、心肌穿孔、大出血、心包填塞、感染性心内膜炎等严重并发症。结论术前联合食管调搏评价窦房结功能，对于非心脏手术老年患者可以起到良好的筛查作用，不同麻醉方式对临时起搏器术中术后起搏无影响，临时起搏器置入方式对并发症发生率无影响。
목적：탐토술전진행두방결공능측정대비심장수술노년환자안치림시기박기적사선개치，병분석마취방식、치입로경등대림시기박적영향급병발증발생풍험적차이。방법납입2009년10월~2012년10월하북대학부속의원외과주원60세이상노년환자112례，균위비심장수술환자，술전심전도시두성심동과완、아탁품시험양성，고균치입림시기박기，이후재경식관심방조박（TEAP）판단두방결공능，주요종점위기박기재술중시부공작，차요종점위환자적일반자료、마취방식、치입도경、병발증등진행총결분석。결과①입조환자중식관조박검사양성자48례（42.86%）；②식관조박양성환자술중술후기박비례고우식관조박음성환자（70.83%vs.10.94%，P＜0.05）；③소유환자안조마취방식분류후발현불동마취방식하술중술후기박비례무통계학의의（전신마취기박vs.련속경막외마취기박vs.국부침윤마취：35.42%vs.31.25%vs.28.57%，P＞0.05）；④불동림시기박기치입방식적병발증발생솔무통계학차이，미발생가성동맥류、심기천공、대출혈、심포전새、감염성심내막염등엄중병발증。결론술전연합식관조박평개두방결공능，대우비심장수술노년환자가이기도량호적사사작용，불동마취방식대림시기박기술중술후기박무영향，림시기박기치입방식대병발증발생솔무영향。
Objective To investigate the screening value of detection of sinus node function to temporary cardiac pacemaker in elderly non-cardiac surgery patients, and analyze the influences of anesthesia methods and inserting routes and difference in risk of complications. Methods The elderly patients (n=112) aged over 60 were chosen from the Affiliated Hospital of Hebei University from Oct. 2009 to Oct. 2012. All patients had undergone non-cardiac surgery, and they were implanted temporary cardiac pacemakers as their ECG showed sinus bradycardia and atropine test showed positive before the operation. The sinus node function was determined through transesophageal atrial pacing (TEAP). The primary endpoint was to determine if pacemakers worked during operation, and secondary endpoint was to sum up and analyze the general data, anesthesia methods, inserting routes of pacemaker and complications. Results ①There were 48 cases (42.86%) showing positive results in TEAP. ②The percentages of pacemaking during and after operation were higher in the patients with positive results in TEAP than that in those with negative results in TEAP (70.83%vs. 10.94%, P<0.05). ③The percentages of pacemaking during and after operation showed no statistical significance after all patients were divided into groups according to anesthesia methods (general anesthesia vs. continuous epidural anesthesia vs. local infiltration anesthesia:35.42%vs. 31.25%vs. 28.57%, P>0.05). ④The incidence of complications, such as pseudoaneurysm, myocaridal perforation, massive hemorrhage, cardiac tamponade and infective endocarditis, had no statistical difference in different routes of pacemaker implantation. Conclusion The reviewing of sinus node function by TEAP has a good screening effect in elderly non-cardiac surgery patients before operation. Different anesthesia methods have no influences on the pacemaking of temporary cardiac pacemakers during and after operation, and the routes of implantation have no influences on the incidence of complications.