心脏起搏系统更换原因及临床分析.docVIP

心脏起搏系统更换原因及临床分析[摘要] 目的:回顾性分析埋藏式起搏器更换的原因和方法,并对不同的更换原因进行分析。方法:对68例起搏器系统更换患者的临床资料,电极参数,更换方式等进行分析。结果:共68例72人次更换起搏器,其中,男42例,女26例;年龄46～92岁,平均(69.0±9.5)岁。其中64例更换1次,4例更换2次。在所有68例更换起搏器的患者中,起搏器电池耗竭60例次,其中,自然耗竭55例次,提前耗竭5例次;电极导线断裂或绝缘层破裂2例;起搏器电重设因未发现而重新植入新的脉冲发生器2例;电极脱位3例;起搏器囊袋破溃1例。在98条电极中,保留电极86条,占87.7%,更换电极12条,更换原因,起搏器阈值升高5条;电极导线绝缘层破裂2条;电极脱位,更换电极3条;电极导线与脉冲发生器分离不开,改到对侧重新植入新电极1条;囊袋破溃而重新在对侧植入1条。结论:起搏器更换原因多为电池耗竭或使用时间已到质保期,少见的原因是起搏器植入并发症。更换电极的主要原因为起搏阈值升高。术前程控电极参数对决定更换方法有重要的指导意义。 [关键词] 心脏起搏器;人工电极;更换 [中图分类号] R654.2 [文献标识码]B[文章编号]1673-7210(2010)04(c)-203-02 Causes and clinical analysis of cardiac pacemaker replacement MENG Jin, QV Haibo, CHEN Xiaoming, LI Zhanquan (Department of Cardiovascular, the People′s Hospital of Liaoning Province, Shenyang110016,China) [Abstract] Objective: To investigate and analyze the causes and methods of cardiac pacemaker replacement. Methods: The clinical data,parameters of leads and methoda of replacement in68 patients undergoing cardiac pacemaker replacement were analyzed. Results: 68 cardiac pacemakers were replaced(42 male and 26 female aged 46-92 years).Among the 68 cases,bateery exhausetion occurred in 60,55 were depletion of battery naturally and 5 ahead of lifetime.Insulation defect of lead occurred in 2.The moving of leads occurred in 3.The reset of the pacemaker occurred in 2.86 leads were reused and 12 leads were disused. The causes of disused leads included:extra-high threshold in5leads,removing of leads in 3, Insulation defect of lead occurred in 2. Conclusion: The main causes of cardiac pacemaker replacement is lifetime expected and depletion of battery,That of disused leads is extra-high threshold.Measuring parameters before operation by programmer is very useful to decide the way of cardiac pacemaker replacement. [Key words] Cardiac pacemaker; Lead; Replacement 随着时间的推移,置入埋藏式心脏起搏器治疗经历了半个世纪,随着人均寿命的延长与置入数量的增多,早期植入心脏起搏器的患者到了更换的时间,起搏器系统更换已成为起搏器置入的重要组成部分,约占16%[1]。本文对我院接受起搏器和(或)电极导线更换手术的资料进行分析,探讨不同的更换原因和方法。 1对象与方法 1.1