慢性心力衰竭患者双心室起搏器植入术后的护理

目的总结慢性心力衰竭（chronic heart failure,CHF）患者双心室起搏器植入术后的护理要点,尤其是心理干预及患者教育的作用。方法对2009年3月-2010年5月收治的34例接受双心室起搏治疗的CHF患者进行观察和全面护理,主要是进行心理干预及患者教育,并在出院后进行长时间随访。结果患者在双心室起搏器植入术后的随访过程中,心力衰竭症状缓解,左心室射血分数、心输出量、左心室充盈时间增加。结论双心室起搏植入术后,辅以全面合理的护理措施,尤其是心理干预及患者教育可以进一步防止并发症的发生,有利于患者改善预后,提高生活质量。     

双心室起搏治疗慢性心力衰竭患者的护理与生活质量评价

目的 观察双心室起搏对慢性心力衰竭患者生活质量的影响，定量反应该治疗的效果。方法 慢性心力衰竭伴室内传导阻滞患者9例，全部植入三腔双心室起搏器，比较双心室起搏前后患者超声心动图和生活质量的变化。结果 双心室同步起搏后，患者左室射血分数，6min步行距离（m），生活质量评分比治疗前有显著性差异（P〈0．05）。结论 双心室起搏能有效改善慢性心衰患者心肺功能，提高生活质量。     

双心室起搏治疗心力衰竭伴心房颤动的临床疗效分析

分析双心室起搏治疗心力衰竭伴心房颤动的临床疗效。选取接受治疗的心力衰竭伴心房颤动患者32例,在手术实施之前,先通过超声心动图像扫描心尖四腔、心尖二腔、心尖长轴切面以及心底短轴、乳头肌短轴、心尖短轴切面图像,随后进行脱机分析,然后对患者开展植入双心室起搏器手术,手术后1个月分析术前术后的心功能状况。所有接受双心室起搏治疗的患者心功能障碍症状都有明显好转。术后心功能分级、心电图QRS波宽、左心室射血分数、二尖瓣反流等各项数据较术前都有改善,对比具有明显差异(P<0.05)。临床上在治疗心力衰竭伴心房颤动时,应给予双心室起搏手术治疗。     

临时双心室同步化起搏在左心功能不全换瓣术后应用疗效及护理

目的探讨左心功能不全患者换瓣术后使用临时双心室再同步化起搏治疗的疗效及护理。方法回顾5例左心功能不全患者瓣膜置换术同期置入临时双心室起搏治疗后心输出量(CO)、桡动脉收缩压(SBP)、心电图QRS宽度、左心室射血分数(LVEF)变化,比较起搏状态和基础状态下各参数的差异,总结此类患者的护理要点。结果患者再同步化起搏治疗后较基础状态下CO提高0.5~0.6 L/min;SBP提高5~10 mm Hg;QRS时限比术前下降15~35 ms;LVEF增加6%~16%;5例患者均平稳度过围术期。结论临时双心室再同步化起搏治疗可以改善心脏外科左心功能不全患者心功能,做好双心室起搏治疗期间生命体征、心电监护、血流动力学监测及并发症预防和处理,是患者安全度过围术期的重要保证。     

生理性起搏与心室起搏对冠心病心律失常患者心脏耐力,生存质量及心功能的

目的：比较生理性起搏与心室起搏对缓慢型心律失常心脏耐力、生存质量及心功能的影响，方法：安置心室起搏器（ＶＶＩ型起搏器）３３８例，生理性起搏器８２例（其中双腔起搏器３２例）术后进行随访。结果：安置两种起捕器后患心脏耐力生存质量提高，心功能明显改善，晕阙症全部消失，尤以生理性起搏明显。结论：生理性起搏对患心脏耐力、生存质量及心功能的改善作用更好。     

双心室起搏与右心室起搏对充血性心力衰竭急性心功能的影响

目的最近研究提示心脏再同步治疗有效地改善了慢性心肌病心力衰竭患者心功能。本研究旨在探讨双心室和右心室起搏对心功能的相对影响。方法 15例慢性心力衰竭患者心功能Ⅲ级,左心室射血分数〈35%,QRS〉130ms和二尖瓣反流。安装心房-双心室再同步起搏器。彩色多普勒超声心动图观察心功能变化。结果急性双心室和右心室起搏并未影响左心室内径和短轴缩短率,也不影响左心室射血速度和排血量。左心室压力上升和下降峰速率无明显变化。等容收缩时间缩短（P〈0.05）,但不影响等容舒张时间。增加Z比例（P〈0.05）。缩短二尖瓣反流时间（P〈0.05）,对二尖瓣环和三尖瓣环运动幅度和峰速率无明显影响。双心室和右心室起搏之间无明显差别。结论双心室起搏改善了慢性心肌病心功能。双心室和右心室起搏无明显差别。双心室起搏是一种有前途的心脏再同步治疗方法。     

心律失常患者起搏器置换术的护理

介绍了25例心室VVI起搏器置换病人的护理，包括术前准备、术后心电监护、并发症的观察与护理、出院指导等。主要包括专科护士掌握起搏器置换适应症，术前配合医生对患行X线检查，测试原起搏电极参数以确定置换方案；术后严密心电监护，观察起搏器起搏、感知功能；适当限制新安置起搏器侧肢体的活动，防止电极导线脱位；观察伤口渗情况以及囊袋有无感染或血肿；出院前行健康宣教和生活指导，嘱患定期随访等。25例病人置换术后，起搏与感知功能均良好。     

经胸壁心内膜起搏复苏三例患者的护理体会

作者报告了3例急性心肌梗塞合并心脏停搏采用经胸壁心内膜起搏成功的抢救配合和护理体会，此方法对具有血流动力学障碍的缓慢心律失常或心室停搏在药物治疗不能奏效的情况下能不失时机地进行紧急心脏起搏，从而在根本上对抗过缓心率，有效提高心排血量，确保复苏成功率。作者就CCU护士在起搏术中的配合，术后对起搏器功能的严密监测、分析、判断以及病情观察等临床护理方面进行了经验总结。     

双心室起搏治疗慢性心力衰竭患者的护理与生活质量评价

目的 观察双心室起搏对慢性心力衰竭患者生活质量的影响,定量反应该治疗的效果.方法 慢性心力衰竭伴室内传导阻滞患者9例,全部植入三腔双心室起搏器,比较双心室起搏前后患者超声心动图和生活质量的变化.结果 双心室同步起搏后,患者左室射血分数,6 min步行距离(m),生活质量评分比治疗前有显著性差异(P＜0.05).结论 双心室起搏能有效改善慢性心衰患者心肺功能,提高生活质量.     

双心室再同步化起搏治疗充血性心力衰竭患者的效果与护理

目的探讨双心室再同步化起搏治疗充血性心力衰竭患者的疗效及护理。方法比较63例充血性心力衰竭患者术前及行双心室再同步化起搏治疗术后的心功能NYHA分级、心电图QRs时限、左心室射血分数LVEF以及运动耐量6min步行距离,并对患者的护理措施进行总结。结果患者治疗后6个月NYHA从术前（3．40±0．50）级改善为术后（2．30±0．60）级,QRS时限从（144．68±16．40）1]ms降至（100．02±14．76）ms,LVEF（％）从（33．18±5．60）提高至（41．8±7．45）,6min步行距离从（305．40±30．30）m提高至（406．20±70．50）m,差异均有统计学意义（t=11．18,4．562,6．728,10．426;P〈0．01）;术后跟踪随访3—24个月,无一例死亡。结论双心室再同步化起搏是治疗充血性心力衰竭患者的一种有效治疗方法,能明显改善患者心脏功能及生活质量。做好术前心理护理、术中心电监测、术后观察和预防并发症的发生以及重视出院后跟踪随访等都是取得较佳疗效的重要保证。     

Perioperative biventricular pacing leads to improvement of hemodynamics in patients with reduced left-ventricular function--interim results

BACKGROUND: Cardiac resynchronization therapy (CRT) has been introduced as a new therapeutic modality in patients with chronic heart failure. However, most studies have investigated the hemodynamic effects in congestive, but not postoperative heart failure. OBJECTIVE: The following study investigates hemodynamic effects of perioperative temporary biventricular pacing in patients undergoing open heart surgery.In 54 patients one left and one right ventricular epicardial wire was placed during open heart operations. Hemodynamic parameters were measured immediately after the operation and 6 as well as 24 hours postoperatively. Transesophageal echocardiography was performed 1 hour postoperatively. RESULTS: Of the 54 patients (59.2%), 32 responded to biventricular pacing with an increase in cardiac output; in these patients synchronized ventricular contraction could be verified echocardiographically. This hemodynamic benefit persisted 6 hours and 24 hours postoperatively. The remaining 22 patients did not show any hemodynamic improvement from biventricular stimulation. CONCLUSION: Biventricular pacing leads to significant rise in cardiac output in approximately 59% of patients with severely reduced left ventricular function and widened QRS complexes. Further studies are necessary to define clearly the clinical characteristics of patients who show remodeling by CRT.     

Triple-site ventricular pacing in a biventricular pacing system

This case report describes a patient with heart failure in whom a biventricular pacing system was successfully implanted. During control of the pacing system, three morphologies of the paced QRS complex could be elucidated. Right ventricular stimulation, biventricular stimulation, and biventricular pacing with additional stimulation from the anodal electrode of the right ventricular lead determined the morphologies.     

心脏临时起搏在老年患者围手术期中的应用及护理

目的总结心脏临时起搏在老年患者围手术期中应用的护理经验。方法回顾分析21例老年围手术期患者应用心脏临时起搏器的护理,包括心理护理、术中配合、术后心率、心律监测及临时起搏器的护理等。结果 21例床边安置临时起搏器均获得成功,手术顺利完成,18例术后3 d内去除起搏电极后自主心率恢复良好,3例出现起搏器依赖, 须安置永久起搏器。结论术前加强心理护理,取得患者配合,术中根据患者年龄特点做好起搏频率及起搏阈的调节,术后加强心率、心律监测及临时起搏器的护理等是确保起搏器有效工作、使手术顺利完成的关键。     

双心室再同步起搏对慢性心力衰竭患者短期疗效观察（附37例分析）

目的：观察心脏再同步化治疗对慢性心力衰竭（CHF）患者的短期临床疗效。方法：对37例CHF患者行双心室再同步起搏治疗前和起搏后6个月的心功能分级（NYHA）,左室射血分数（LVEF）,6min步行试验,心电图QRS波群时限,最大摄氧量（VO2MAX）,生活质量（QOL）作自身对比分析。结果：NYHA,LVEF均有明显改善;QRS时限缩短;6min步行距离由298.48±80.60m上升至375.31±82.51m,提高了25%;VO2MAX绝对值（L.min^-1）由768.18±325.24升至918.39±443.87,VO2MAX相对值（L.min^-1.kg^-1）由12.95±3.95提高至15.52±5.67,QOL评分由22.70±16.10降至8.86±9.40,均有显著差异。结论：双心室起搏能够有效地改善具有心室传导延迟、心脏收缩不同步的慢性心力衰竭患者的心功能,提高生活质量,是治疗慢性心力衰竭的有效方法。     

Right heart failure due to loss of right ventricular capture in a patient with atrioventricular junction ablation and biventricular pacing

We describe the case of a patient with atrioventricular (AV) junction ablation and chronic biventricular pacing in which intermittent dysfunction of the right ventricular (RV) lead resulted in left ventricular (LV) stimulation alone and onset of severe right heart failure. Restoration of biventricular pacing by increasing device output and then performing lead revision resolved the issue. This case provides evidence that LV pacing alone in patients with AV junction ablation may lead to severe right heart failure, most likely as a result of iatrogenic mechanical dyssynchrony within the RV. Thus, probably this pacing mode should be avoided in pacemaker-dependent patients with heart failure.     

Accelerometer-derived time intervals during various pacing modes in patients with biventricular pacemakers: comparison with normals

INTRODUCTION: Changes due to biventricular pacing have been documented by shortening of QRS duration and echocardiography. Compared to normal ventricular activation, the presence of left bundle branch block (LBBB) results in a significant change in cardiac cycle time intervals.Some of these have been used to quantify the underlying cardiac dyssynchrony, assess the effects of biventricular pacing, and guide programming of ventricular pacing devices. This study evaluates a simple noninvasive method using accelerometers attached to the skin to measure cardiac time intervals in biventricularly paced patients. METHODS: Ten patients with biventricular pacemakers previously implanted for congestive heart failure were paced in the AAI mode, then in atrioventricular (AV) sequential mode from the right and left ventricles followed by biventricular pacing. Simultaneous recordings were obtained by 2D, Doppler echocardiography as well as by accelerometers. Similar recordings were obtained from 10 gender, aged matched, normal controls during sinus rhythm. RESULTS: Compared to normals, heart failure patients paced in AAI mode had prolonged isovolumetric contraction time (IVCT), shorter ventricular ejection time (LVET), and prolonged isovolumetric relaxation (IVRT). With biventricular pacing the IVCT decreased, but the LVET and IVRT did not change significantly. There was excellent correlation between the echo and accelerometer-measured intervals. CONCLUSIONS: Shortening of the IVCT measured by an accelerometer is a consistent time interval change due to biventricular pacing that probably reflects more rapid acceleration of left ventricular ejection. The accelerometer may be useful to assess immediate efficacy of biventricular pacing during device implantation and optimize programmable time intervals such as AV and interventricular (VV) delays.     

Left ventricular and biventricular pacing in congestive heart failure

Dual-chamber pacing improved hemodynamics acutely in a subset of patients with left ventricular (LV) dysfunction but conveyed no long-term symptomatic benefit in most. More recently, LV pacing and biventricular (multisite) pacing have been used to improve systolic contractility by altering the electrical and mechanical ventricular activation sequence in patients with severe congestive heart failure (CHF) and intraventricular conduction delay or left bundle branch block (LBBB). Intraventricular conduction delay and LBBB cause dyssynchronous right ventricular and LV contraction and worsen LV dysfunction in cardiomyopathies. Both LV and biventricular cardiac pacing are thought to improve cardiac function in this situation by effecting a more coordinated and efficient ventricular contraction. Short-term hemodynamic studies have shown improvement in LV systolic function, which seems more pronounced with monoventricular LV pacing than with biventricular pacing. Recent clinical studies in limited numbers of patients suggest long-term clinical benefit of biventricular pacing in patients with severe CHF symptoms. Continuing and future studies will demonstrate whether and in which patients LV and biventricular pacing are permanently effective and equivalent and which pacing site within the LV produces the most beneficial hemodynamic results.     

Transatrial dual chamber biventricular pacemaker-defibrillator placement in a patient with SVC obstruction

A patient with severe congestive heart failure and obstruction of the superior vena cava required biventricular pacing and ICD therapy. Via right minithoracotomy, a transatrial approach for lead placement was successfully utilized to provide cardiac resynchronization and ICD placement. This technique for pacing lead placement is reviewed and its application for biventricular pacemaker-defibrillator placement is reported.     

Abrupt Heart Rate Fallings in a Patient with Biventricular Pacing: Latent Risk for Exacerbation of Heart Failure

This case report describes abrupt heart rate fallings below the lower pacing rate limit in a patient with cardiac resynchronization therapy (CRT). Interrogated information including stored episodes or data regarding the lead did not show any device problems and only simultaneous intracardiac electrogram revealed the cause, T‐wave oversensing during biventricular pacing. At this moment, CRT has become an established modality for patients with severe heart failure. However, bradycardia below the lower rate limit during biventricular pacing due to T‐wave oversensing would exacerbate heart failure in patients with CRT. We should notice this latent risk and correct the malfunction immediately. (PACE 2010; 1–4)