CAJ | 학술논문

目的总结永久心外膜起搏在起搏器依赖的起搏装置相关感染性心内膜炎中的应用病例,探讨其可行性,为此类疾病的治疗提供新的思路.方法回顾北京大学人民医院联合拔除心内起搏导线并应用永久心外膜起搏的病例资料,分析病例特点,探索永久心外膜起搏的应用规律.共3例起搏器依赖的起搏装置相关感染性心内膜炎选择拔除原心内起搏导线及脉冲发生器并联合永久心外膜起搏治疗.选择永久心外膜起搏的原因,持续败血症不能控制,全身情况差,不能耐受体外循环手术,三尖瓣处存在较大赘生物1例;不宜应用心内电极1例;上腔静脉闭塞不宜经锁骨下静脉放置心内起搏电极1例.结果 3例感染性心内膜炎患者拔除心内感染电极导线及移除起搏装置后应用永久心外膜起搏,患者均获治愈,随访2 ～12个月,无感染复发,起搏器工作良好.结论起搏器依赖的严重、高危起搏装置相关感染性心内膜炎患者移除心内感染电极导线及起搏装置后不宜经静脉再次置入起搏装置者可以选择永久心外膜起搏.
목적 총결영구심외막기박재기박기의뢰적기박장치상관감염성심내막염중적응용병례,탐토기가행성,위차류질병적치료제공신적사로.방법 회고북경대학인민의원연합발제심내기박도선병응용영구심외막기박적병례자료,분석병례특점,탐색영구심외막기박적응용규률.공3례기박기의뢰적기박장치상관감염성심내막염선택발제원심내기박도선급맥충발생기병연합영구심외막기박치료.선택영구심외막기박적원인,지속패혈증불능공제,전신정황차,불능내수체외순배수술,삼첨판처존재교대췌생물1례;불의응용심내전겁1례;상강정맥폐새불의경쇄골하정맥방치심내기박전겁1례.결과 3례감염성심내막염환자발제심내감염전겁도선급이제기박장치후응용영구심외막기박,환자균획치유,수방2 ～12개월,무감염복발,기박기공작량호.결론 기박기의뢰적엄중、고위기박장치상관감염성심내막염환자이제심내감염전겁도선급기박장치후불의경정맥재차치입기박장치자가이선택영구심외막기박.
Objective Permanent epicardial pacemaker is seldom used clinically and it is even less likely to be used for the treatment of seriously ill pacing-dependent patients with cardiac electronic device related endocarditis.Method We retrospectively analyzed the feasibility and efficacy of permanent epicardial pacing for the treatment of 3 pacing-dependent patients with cardiac electronic device related endocarditis,who were treated by removal of all pacemaker devices and reimplantation of permanent epicardial pacing system combined with antibiotics.The reason of using epicardial pacing system was as follows:uncontrolled sepsis (case 1) ; big vegetation on the electrode of pacemaker and tricuspid valve but not a candidate for open heart surgery because of high operative risk (case 2) ; occlusion of superior vena cava (case 3).Results All 3 patients were cured with the treatment of extraction of infected pacing system,re-implanted permanent epicardial pacing system and antibiotics.The permanent epicardial pacemaker worked well during the 2-12 months follow-up period and there was no recurrence of infection.Conclusions Permanent epicardial pacing is useful and efficient in treatment of seriously ill and high risk pacing-dependent patients with cardiac device related endocarditis.