CAJ | 학술논문

目的探讨80岁及以上患者起搏器植入适应证、起搏方式、起搏参数及术后并发症.方法连续选取行起搏器治疗的高龄老年患者112例(80～94岁组),普通老年患者484例(60～79岁组),随访观察两组患者植入起搏器适应证、起搏方式、起搏参数及术后并发症的特点. 结果 80～94岁组冠心病58例(51.8％),与60～79岁组163例(33.7％)比较,差异有统计学意义(x2=12.78,P＜0.01);80～94岁组单腔起搏器植入患者为63例(56.3％),双腔或多腔起搏器49例(43.8％),与60～79岁组217例(44.8％)、267例(55.2％)比较,差异有统计学意义(x2分别为4.76、4.76,均P＜0.05);因双束支传导阻滞植入起搏器患者19例(17.0％),高于60～79岁组31例(6.4％),差异有统计学意义(x2 =13.20,P＜0.01);术后急性脑梗死并发症发生率均高于60～79岁组(P＜0.01);80～94岁组心室起搏阈值、心房起搏阈值(0.78±0.24)V、(1.07±0.22)V,较60～79岁组(0.55±0.16)V、(0.84±0.28)V增高(均P＜0.05). 结论应正确认识高龄老年患者起搏器治疗的特殊性,在全面评估其临床状况的条件下合理地选择起搏治疗以取得最大的临床效果.
목적 탐토80세급이상환자기박기식입괄응증、기박방식、기박삼수급술후병발증.방법 련속선취행기박기치료적고령노년환자112례(80～94세조),보통노년환자484례(60～79세조),수방관찰량조환자식입기박기괄응증、기박방식、기박삼수급술후병발증적특점. 결과 80～94세조관심병58례(51.8％),여60～79세조163례(33.7％)비교,차이유통계학의의(x2=12.78,P＜0.01);80～94세조단강기박기식입환자위63례(56.3％),쌍강혹다강기박기49례(43.8％),여60～79세조217례(44.8％)、267례(55.2％)비교,차이유통계학의의(x2분별위4.76、4.76,균P＜0.05);인쌍속지전도조체식입기박기환자19례(17.0％),고우60～79세조31례(6.4％),차이유통계학의의(x2 =13.20,P＜0.01);술후급성뇌경사병발증발생솔균고우60～79세조(P＜0.01);80～94세조심실기박역치、심방기박역치(0.78±0.24)V、(1.07±0.22)V,교60～79세조(0.55±0.16)V、(0.84±0.28)V증고(균P＜0.05). 결론 응정학인식고령노년환자기박기치료적특수성,재전면평고기림상상황적조건하합리지선택기박치료이취득최대적림상효과.
Objective To investigate indications,pacing modes,pacing parameters and postoperative complications of pacemaker implantation for patients aged 80 years or over.Methods Patients were recruited on a continuous basis and were assigned into two groups,with 112 patients in the very elderly (80-90 years old) group and 484 patients in the elderly (60-79 years old) group,which served as the control.Follow-up observations with the two groups were conducted concerning indications,mode selection,pacing parameters and postoperative complications.Results Compared with the control group,the very elderly group showed:1) a higher rate of coronary heart disease (58cases vs.163 cases or 51.8％ vs.33.7％ ; x2 =12.78,P＜0.01) ; 2) more single-chamber pacemaker implantations (63 cases vs.217 cases or 56.3％ vs.44.8％; x2=4.76,P＜0.05) and fewer dual-or multi-chamber pacemaker implantations (49 cases vs.267 cases or 43.8％ vs.55.2％ ; x2 =4.76,P＜0.05) ; 3) a higher rate of double bundles branch block (19 cases vs.31 cases or 17.0％ vs.6.4％ ; x2=13.20,P＜0.01); 4) a higher rate of postoperative acute cerebral infarction (x2 =8.34,P＜0.01) ; and 5) increased ventricular [(0.78±0.24)V vs.(0.55±0.16)V,P＜0.05]and atrial [(1.07±0.22)V vs.(0.84±0.28)V,P＜0.05]pacing thresholds.Conclusions Special considerations should be made when pacemaker implantation is planned for patients aged 80 or over.Pacemaker selection decisions ought to be based on a comprehensive evaluation of relevant clinical situations so that clinical benefits can be maximized.