CAJ | 학술논문

目的探讨食管心房调搏在筛选窦性心动过缓的老年患者行非心脏手术围术期间应用临时起搏器的价值.方法入选2010年7月至2013年12月在信阳市中心医院行非心脏手术的老年患者179例(年龄≥60岁),所有患者术前心电图提示窦性心动过缓,进一步随机采用阿托品试验阳性或食管心房调搏阳性筛查需要临时起搏器植入,其中,阿托品试验阳性组(阿托品组)93例及食管心房调搏阳性组(食管心房调搏组)86例,根据临时起搏器在术中、术后是否起搏,在阿托品组与食管心房调搏组内将患者分为起搏组与备用组.结果所有入选者临时起搏器植入均成功,围术期无感染、心脏穿孔等并发症发生.食管心房调搏组患者围术期起搏器完全或部分起搏的比率为84.9％ (73/86),显著高于阿托品组患者围术期起搏器完全或部分起搏的比率69.9％ (65/93)(P＜0.05),且食管心房调搏组患者围术期起搏器未起搏的比例15.1％ (13/86)显著低于阿托品组患者围术期起搏器未起搏的比例30.1％ (28/93)(P＜0.05).结论食管心房调搏在预测合并窦性心动过缓的老年患者行非心脏手术时应用临时起搏器的特异性和敏感性均显著高于阿托品试验.
목적 탐토식관심방조박재사선두성심동과완적노년환자행비심장수술위술기간응용림시기박기적개치.방법 입선2010년7월지2013년12월재신양시중심의원행비심장수술적노년환자179례(년령≥60세),소유환자술전심전도제시두성심동과완,진일보수궤채용아탁품시험양성혹식관심방조박양성사사수요림시기박기식입,기중,아탁품시험양성조(아탁품조)93례급식관심방조박양성조(식관심방조박조)86례,근거림시기박기재술중、술후시부기박,재아탁품조여식관심방조박조내장환자분위기박조여비용조.결과 소유입선자림시기박기식입균성공,위술기무감염、심장천공등병발증발생.식관심방조박조환자위술기기박기완전혹부분기박적비솔위84.9％ (73/86),현저고우아탁품조환자위술기기박기완전혹부분기박적비솔69.9％ (65/93)(P＜0.05),차식관심방조박조환자위술기기박기미기박적비례15.1％ (13/86)현저저우아탁품조환자위술기기박기미기박적비례30.1％ (28/93)(P＜0.05).결론 식관심방조박재예측합병두성심동과완적노년환자행비심장수술시응용림시기박기적특이성화민감성균현저고우아탁품시험.
Objective To investigate the clinical significance of transesophageal atrial pacing in screening the applications of temporary pacemaker in aged surgical patients with non-cardiac surgery.Methods From July 2010 to December 2013,some aged patients with sinus bradycardia who would been operated in surgery of our hospital were enrolled and all conducted the examination of atropine test or transesophageal atrial pacing,with 93 patients positive in atropine test (atropine group) and 86 patients positive in transesophageal atrial pacing (transesophageal atrial pacing group),and according to whether the pacemaker worked during the period of temporary pacemaker implant,the patients were divided into pacemaker group and standby group in atropine group and transesophageal atrial pacing group respectively.The pacemaker were completely or partly pacing in the pacing group while the pacemaker were not at all pacing in the standby group during the period of temporary pacemaker implant.Results All the operations of implantations of temporary pacemaker were successful and no complications happened during the period of temporary pacemaker implantations.The percentage of complete or partly pacing of temporary pacemaker was higher in transesophageal atrial pacing group than that in atropine group (P ＜ 0.05);What' s more,the percentage of no pacing of temporary pacemaker was lower in transesophageal atrial pacing group than that in atropine group (P ＜ 0.05).Conclusions The transesophageal atrial pacing in screening of applications of temporary pacemaker in old surgical patients with non-cardiac surgery is superior to atropine test.