永久心脏起搏电极导线在临时心脏起搏中的实用性和成本效益

目的 探讨应用永久心脏起搏电极导线连接外置可重复使用的永久起搏器进行临时心脏起搏（TCP）的实用性和成本效益。方法 将具有TCP适应证的48位患者分为研究组（n=18）和对照组（n=30）。 研究组应用永久心脏起搏电极导线连接外置可重复使用的永久起搏器进行TCP;对照组进行传统方法TCP。 结果 研究组18例及对照组30例患者均成功地进行了TCP。研究组中有6例采用了主动螺旋起搏电极导线,另外12例应用翼状被动起搏电极导线。 研究组因为可逆性原因所致心动过缓进行TCP的比例（10 /18）高于对照组（8 /30）;而因永久起搏器植入前保护性TCP的比例（3/18）小于对照组（16/30）（P〈0.05）。 研究组患者全部而对照组仅有17%经锁骨下静脉途径进行TCP（P〈0.05）。 研究组TCP应用时间长于对照组[（7.9±6.5）d vs （3.9±2.3）d,P〈0.05]。 研究组因TCP而住CCU病房的时间短于对照组[（0.2±0.5）d vs （2.6±1.2）d,P〈0.05]。 对照组起搏电极导线脱位33次而研究组无脱位。 对照组有1例患者发生心包压塞。 两组与TCP相关的总医疗花费相当（未计算起搏器费用）。 结论 应用永久心脏起搏电极导线连接外置可重复使用的永久起搏器进行TCP,实用性强且不增加医疗经费。

Utility and cost effectiveness of temporary cardiac pacing using permanent leads and an externally placed reusable pacemaker.

Objective To investigate utility and cost effectiveness of temporary cardiac pacing （TCP） using permanent leads and an extemally placed reusable permanent pacemaker. Methods Forty-eight patients in whom TCP was conducted were divided into research group（ n = 18）and contrast group （n = 30）. TCP of research group used permanent leads and an externally placed reusable pacemaker, and contrast group was traditional TCP group. Results TCP were successfully performed in 18 research group patients and in 30 contrast group patients. Active-fixation permanent pacing leads and pas- sive-fixation permanent pacing leads were applied in 6 and 12 research group patients. The incidence of TCP for reversible bradycardia in research group （10/18）was higher than that in contrast group（8/30）, and the incidence of protective TCP before permanent pacemaker implantation in research group （3/18）was lower than that in contrast group （16/30） （P〈0. 05 ）. Leads were placed to right ventricle via subclavian vein in all patients of research group and 17% patients（5/30） of contrast group. TCP application time in research group [ （7.9±6.5）d ] was longer than that in contrast group [ （3.9±2.3） d ]. The duration of patient in CCU ward for TCP reason was longer in traditional TCP group [ （0.2±0.5） d vs （ 2.6± 1.2 ） d,P〈0.05 ]. There were 33 times of lead dislodgement in traditional TCP group whereas no lead dislodgement was occurred in research group. Cardiac tamponade was occurred in one contrast group patient. Total medical costs related to TCP were equivalent in both group （ Cost of pacemaker was not calculated. ）. Conclusions TCP using permanent leads and an externally placed reusable pacemaker has high practicability and do not increase the medical costs related to TCP.