CAJ | 학술논문

目的探讨小儿安装右心室心尖部心内膜单腔永久性起搏器的临床效果.方法收集2007年6月至2012年10月经静脉安装右心室心尖部心内膜单腔永久性起搏器的7例患儿的临床资料.男5例,女2例;年龄2岁10个月～12岁10个月;体质量12.5 ～52.5 kg.基础病因为病毒性心肌炎3例,先天性Ⅲ度房室传导阻滞2例,室间隔缺损外科修补术后2例.心电图示心室率38 ～72(46.5±7.6)次/min.选择右心室心尖部心内膜单腔永久性起搏,起搏导线置入路径经锁骨下静脉.术后1、3、6个月及每0.5年参与临床随访,行心电图、胸片、超声心动图检查,并对起搏参数进行检测.结果起搏器电极导线均为双极起搏电极;起搏器类型为频率适应性心室起搏(VVIR)5例,频率固定心室起搏(ⅤⅥ)2例;起搏器囊袋置于胸大肌下6例,皮下1例;1例术后2周出现囊袋感染,1例术后6年更换起搏器,并由单腔起搏模式变为双腔起搏模式.7例患儿随访1 ～7年,心电图示起搏功能良好,心脏超声示心脏大小及功能保持在正常范围,未发现心功能不全及死亡病例.结论小儿右心室心尖部心内膜单腔永久性起搏安全、有效,应注意常规随访.
목적 탐토소인안장우심실심첨부심내막단강영구성기박기적림상효과.방법 수집2007년6월지2012년10월경정맥안장우심실심첨부심내막단강영구성기박기적7례환인적림상자료.남5례,녀2례;년령2세10개월～12세10개월;체질량12.5 ～52.5 kg.기출병인위병독성심기염3례,선천성Ⅲ도방실전도조체2례,실간격결손외과수보술후2례.심전도시심실솔38 ～72(46.5±7.6)차/min.선택우심실심첨부심내막단강영구성기박,기박도선치입로경경쇄골하정맥.술후1、3、6개월급매0.5년삼여림상수방,행심전도、흉편、초성심동도검사,병대기박삼수진행검측.결과 기박기전겁도선균위쌍겁기박전겁;기박기류형위빈솔괄응성심실기박(VVIR)5례,빈솔고정심실기박(ⅤⅥ)2례;기박기낭대치우흉대기하6례,피하1례;1례술후2주출현낭대감염,1례술후6년경환기박기,병유단강기박모식변위쌍강기박모식.7례환인수방1 ～7년,심전도시기박공능량호,심장초성시심장대소급공능보지재정상범위,미발현심공능불전급사망병례.결론 소인우심실심첨부심내막단강영구성기박안전、유효,응주의상규수방.
Objective To investigate the clinical effects of pediatric patients after implantation of pernanent single chamber right ventricle apex endocardial pacemakers.Methods Seven cases were implanted with permanent pacemakers from June 2007 to October 2012 and transvenous endocardial insertion was performed in all the patients.Five of them were boys,and 2 cases were girls.The ages ranged from 2 years and 3 months to 13 years and 10 months.The weight ranged from 12.5 kg to 52.5 kg.Three cases of them were viral myocarditis.Two cases were congenital Ⅱ-degree atrioventricular block.Two cases were acquired atrioventricular block after cardiac surgery for correction of ventricular septal defect.The ventricular rate on electrocardiogram was 38-72(46.5 ±-7.6) beats per minute.The pacing lead was implanted into right ventricle through subclavian.The patients were followed up for 1,3,and 6 months after implantation,and then every 6 months or as needed.Electrocardiogram,X-ray,echocardiogram examination,and parameters of pacemaker should be noticed and follow-up study should be conducted.Results Pacemaker electrode leads were all bipolar pacing electrode.Ventricular pacing,ventricular sensing,inhibition response and rate adaptive (ⅤⅥR) mode devices were in 5 patients.Ventricular pacing,ventricular sensing and inhibition response (ⅤⅥ) mode devices were in 2 patients.Six pacemakers were implanted into ectopectoralis and 1 pacemaker was implanted into subcutaneous tissue.Pacemakers sac infections presented in 1 case after 2 weeks postoperatively.Single chamber pacing was replaced by dual chamber pacing in 1 case after 6 years postoperatively.The follow-up period was from 1 year to 7 years.Cardiac chamber sizes and cardiac functions for 7 patients maintained normal during follow-up.Pacing status and sensitivity were satisfactory for all these patients during follow-up.Heart failure was not found and none of them died.Conclusions Permanent single chamber right ventricle apex endocardial pacing anong the pediatric population was safe and effective.Follow-up assessment was needed.