中国循环杂志
中國循環雜誌
중국순배잡지
CHINESE CIRCULATION JOURNAL
2015年
8期
777-780
,共4页
张浩%张涛%李守军%张惠丽%花中东
張浩%張濤%李守軍%張惠麗%花中東
장호%장도%리수군%장혜려%화중동
先天性心脏病%永久性起搏器%外科
先天性心髒病%永久性起搏器%外科
선천성심장병%영구성기박기%외과
Congenital heart diseases%Permanent pacemaker%Surgery
目的：本研究总结回顾了单中心先天性心脏病（先心病）外科围手术期心外膜永久性起搏器植入经验和远期随访结果。<br> 方法：回顾性分析2002年-2014年间我院33例8岁以下先心病患儿外科围术期植入心外膜永久性起搏器的临床资料。先天性高度房室传导阻滞6例，医源性高度房室传导阻滞27例。患儿平均年龄（23.2±26.9）个月，平均体重（9.7±5.6） kg。除6例术中即植入起搏器外，其余均于术后（26.0±13.1） d植入起搏器。起搏导线植入于右心室膈面，起搏器均放置于腹直肌后的囊袋。术中收集起搏器植入时间、类型、植入后即刻心室夺获阈值，电极电阻等电生理学信息。随访期间，收集心脏超声心动图、心电图、起搏器电程控信息和恶性心血管事件的发生。术后随访（46.8±33.9）个月。<br> 结果：除2例因先天性传导阻滞植入双腔起搏器外，其余均植入单腔起搏器。起搏器植入后即刻心室夺获阈值（1.34±0.72）V，而末次随访时未见心室夺获阈值明显增加[（1.37±0.81）V，P=0.93]。与植入起搏器即刻比，末次随访时的心室电极电阻[（366.7±88）Ω vs (331.9±95.9)Ω，P=0.32]和R波振幅[（12.3±3.5） mV vs（11.4±4.9） mV，P=0.635]均无明显升高。随访期间4例患儿术后因电池耗竭行起搏器置换术；21.2%（7/33）患儿出现心力衰竭或猝死的恶性心血管事件，发生恶性心血管事件的患儿的年龄和体重与预后良好的患儿相比差异无统计学意义（P>0.05）。随访期间所有患儿均未发生囊袋感染及起搏器电极折断的情况。<br> 结论：医源性高度房室传导阻滞是目前先心病外科围术期植入永久性起搏器的首位原因。心外膜永久性起搏器植入有较好的远期随访效果，但是起搏器类型的选择仍需进一步优化。
目的：本研究總結迴顧瞭單中心先天性心髒病（先心病）外科圍手術期心外膜永久性起搏器植入經驗和遠期隨訪結果。<br> 方法：迴顧性分析2002年-2014年間我院33例8歲以下先心病患兒外科圍術期植入心外膜永久性起搏器的臨床資料。先天性高度房室傳導阻滯6例，醫源性高度房室傳導阻滯27例。患兒平均年齡（23.2±26.9）箇月，平均體重（9.7±5.6） kg。除6例術中即植入起搏器外，其餘均于術後（26.0±13.1） d植入起搏器。起搏導線植入于右心室膈麵，起搏器均放置于腹直肌後的囊袋。術中收集起搏器植入時間、類型、植入後即刻心室奪穫閾值，電極電阻等電生理學信息。隨訪期間，收集心髒超聲心動圖、心電圖、起搏器電程控信息和噁性心血管事件的髮生。術後隨訪（46.8±33.9）箇月。<br> 結果：除2例因先天性傳導阻滯植入雙腔起搏器外，其餘均植入單腔起搏器。起搏器植入後即刻心室奪穫閾值（1.34±0.72）V，而末次隨訪時未見心室奪穫閾值明顯增加[（1.37±0.81）V，P=0.93]。與植入起搏器即刻比，末次隨訪時的心室電極電阻[（366.7±88）Ω vs (331.9±95.9)Ω，P=0.32]和R波振幅[（12.3±3.5） mV vs（11.4±4.9） mV，P=0.635]均無明顯升高。隨訪期間4例患兒術後因電池耗竭行起搏器置換術；21.2%（7/33）患兒齣現心力衰竭或猝死的噁性心血管事件，髮生噁性心血管事件的患兒的年齡和體重與預後良好的患兒相比差異無統計學意義（P>0.05）。隨訪期間所有患兒均未髮生囊袋感染及起搏器電極摺斷的情況。<br> 結論：醫源性高度房室傳導阻滯是目前先心病外科圍術期植入永久性起搏器的首位原因。心外膜永久性起搏器植入有較好的遠期隨訪效果，但是起搏器類型的選擇仍需進一步優化。
목적：본연구총결회고료단중심선천성심장병（선심병）외과위수술기심외막영구성기박기식입경험화원기수방결과。<br> 방법：회고성분석2002년-2014년간아원33례8세이하선심병환인외과위술기식입심외막영구성기박기적림상자료。선천성고도방실전도조체6례，의원성고도방실전도조체27례。환인평균년령（23.2±26.9）개월，평균체중（9.7±5.6） kg。제6례술중즉식입기박기외，기여균우술후（26.0±13.1） d식입기박기。기박도선식입우우심실격면，기박기균방치우복직기후적낭대。술중수집기박기식입시간、류형、식입후즉각심실탈획역치，전겁전조등전생이학신식。수방기간，수집심장초성심동도、심전도、기박기전정공신식화악성심혈관사건적발생。술후수방（46.8±33.9）개월。<br> 결과：제2례인선천성전도조체식입쌍강기박기외，기여균식입단강기박기。기박기식입후즉각심실탈획역치（1.34±0.72）V，이말차수방시미견심실탈획역치명현증가[（1.37±0.81）V，P=0.93]。여식입기박기즉각비，말차수방시적심실전겁전조[（366.7±88）Ω vs (331.9±95.9)Ω，P=0.32]화R파진폭[（12.3±3.5） mV vs（11.4±4.9） mV，P=0.635]균무명현승고。수방기간4례환인술후인전지모갈행기박기치환술；21.2%（7/33）환인출현심력쇠갈혹졸사적악성심혈관사건，발생악성심혈관사건적환인적년령화체중여예후량호적환인상비차이무통계학의의（P>0.05）。수방기간소유환인균미발생낭대감염급기박기전겁절단적정황。<br> 결론：의원성고도방실전도조체시목전선심병외과위술기식입영구성기박기적수위원인。심외막영구성기박기식입유교호적원기수방효과，단시기박기류형적선택잉수진일보우화。
Objective: To analyze the 10-year experience for placement of permanent epicardial-pacemaker (PM) during peri-operative period in a single center of patients with congenital heart diseases (CHD). <br> Methods: A total of 33 CHD patients who received the placement of epicardial-PM during peri-operative period in our hospital from 2002 to 2013 were retrospectively analyzed. There were 6 patients with congenital atrio-ventricular block (AVB) 27 with iatrogenic AVB. All patients were younger than 8 years and the mean age was (23.2 ± 26.9) months, with the body weight at (9.7 ± 5.6) Kg. 6 patients with congenital AVB received surgical PM placement combined with CHD repair, and the other 27 patients received PM placement at (26 ± 13.1) days after the surgery. Steroid-eluting bipolar epicardial pacing leads were inserted through median sternotomy and connected to various pulse generators within the subrectus pocket. The time, type, acute ventricular stimulation sensing, impedance and electrophysiological information of PM were collected during the operation. The patients were followed-up for (46.8 ± 33.9) months for echocardiography, ECG, programming information of PM, and the major adverse cardiac events (MACE) were recorded. <br> Results: There were 2 congenital AVB patients received dual chamber PM and the rest patients received single chamber PM. Acute ventricular stimulation sensing was (1.34 ± 0.72) V, no signiifcant increase was identiifed in the last follow-up examination as (1.37 ± 0.81) V,P=0.93. Compared with immediate PM implantation, no signiifcant increases were observed for impedance and R wave in the last follow-up examination as (366.7 ± 88) Ω vs (331.9 ± 95.9) Ω,P=0.32 and (12.3 ± 3.5) mV vs (11.4 ± 4.9) mV,P=0.635 respectively. There were 4 patients received PM replacement because of generator dysfunction, 7/33 (21.2%) of patients had MACE as heart failure or sudden death. The age and body weight in MACE patients were similar with the patients with good prognosis,P>0.05. No pocket infection or lead fracture occurred. <br> Conclusion: Iatrogenic high level of AVB has been the primary reason for surgical placement of epicardial PM in CHD patients during peri-operative period. It has better long term outcome, while the type of PM should be optimized.
