CAJ | 학술논문

目的心血管植入型电子器械(CIED)导线经静脉途径拔除的安全性和有效性.探讨不同类型导线拔除的成功率.方法选择2004年1月至2014年12月在中国医学科学院阜外医院行经静脉途径拔除导线的患者215例(共计406根导线),回顾性分析导线拔除适应证、拔除工具和方式,拔除导线类型、成功率和并发症.结果共215例患者(共计406根导线)纳入该研究.其中感染174例,导线故障37例,有症状的上腔静脉阻塞综合征4例.拔除右心房电极导线167根,右心室电极导线187根,左心室电极导线19根,除颤电极导线26根.导线拔除总成功率为98.3％(399/406),其中导线完全拔除346根(完全成功率85.2％,346/406);失败3例,共7根导线(失败率1.7％,7/406).比较直接牵拉、锁定钢丝和机械性扩张鞘拔除右心房、右心室和除颤电极导线的成功率,成功率差异无统计学意义(P＞0.05).2例发生严重并发症,1例为心脏压塞,另1例为三尖瓣大量反流.结论经静脉途径拔除导线安全有效.
목적 심혈관식입형전자기계(CIED)도선경정맥도경발제적안전성화유효성.탐토불동류형도선발제적성공솔.방법 선택2004년1월지2014년12월재중국의학과학원부외의원행경정맥도경발제도선적환자215례(공계406근도선),회고성분석도선발제괄응증、발제공구화방식,발제도선류형、성공솔화병발증.결과 공215례환자(공계406근도선)납입해연구.기중감염174례,도선고장37례,유증상적상강정맥조새종합정4례.발제우심방전겁도선167근,우심실전겁도선187근,좌심실전겁도선19근,제전전겁도선26근.도선발제총성공솔위98.3％(399/406),기중도선완전발제346근(완전성공솔85.2％,346/406);실패3례,공7근도선(실패솔1.7％,7/406).비교직접견랍、쇄정강사화궤계성확장초발제우심방、우심실화제전전겁도선적성공솔,성공솔차이무통계학의의(P＞0.05).2례발생엄중병발증,1례위심장압새,령1례위삼첨판대량반류.결론 경정맥도경발제도선안전유효.
Objective To evaluate the effectiveness and safety of the transvenous lead extraction using a standard stepwise approach.Methods We retrospectively identified cases of transvenous lead extractions by simple traction or with the use of non-powered extraction tools in our hospital between Jan 2004 and Dec 2014.The indications for lead extraction,different extraction tools and approaches used in the extraction procedures,success rate and complications were analyzed.Results Lead extraction was attempted in 406 leads from 215 patients.The indications for lead removal included device infection(n=174),lead dysfunction(n=37)and symptomatic central venous obstruction (n =4).One hundred and sixty seven leads in atrial,187 leads in right ventricle,19 leads in left ventricle and 26 implantable cardioverter defibrillater leads were extracted respectively.The total success rate of lead extraction was 98.3％.The complete procedural success rate was 85.2％(346/406).Seven leads in 3 patients had not been extracted.The failure rate was 1.7％(7/406).The success rate of lead extraction had no statistically significance difference among atrial leads、ventricular leads and implantable cardioverter defibrillator leads using simple traction,locking stylets or dilator sheaths (P＞0.05).Major complications included pericardial tamponade(1 case)and tricuspid valve insufficency(1 case).Conclusion Transvenous lead extraction is safe and efficiency.