小儿植入永久性起搏器的并发症及处理体会

目的 分析14例小儿永久性起搏器中4例出现并发症的原因和处理体会。方法 3例感染患儿摘除被感染的整个起搏系统，在对侧胸壁重新埋置管的起搏系统，对原感染灶用优苏溶液湿敷，待新的肉芽组织形成。结果 3例经上述处理后均被治愈，随访6个月无再次出现感染。结论 杜绝术中消毒不严的诱因，术后若出现电极导线或囊袋感染，尽早采取外科清创手术，摘除被感染的整个起搏系统，选择对侧胸壁植入，埋置部位在胸大肌与胸小肌，术后3个月内限制其活动。     

小儿植入永久性起搏器的并发症及处理体会

目的　 分析 14例小儿永久性起搏器中 4例出现并发症的原因和处理体会。 方法 　 3例感染患儿摘除被感染的整个起搏系统 ,在对侧胸壁重新埋置新的起搏系统 ,对原感染灶用优苏溶液湿敷 ,待新的肉芽组织形成。 结果 　 3例经上述处理后均被治愈 ,随访 6个月无再次出现感染。 结论 　杜绝术中消毒不严的诱因 ,术后若出现电极导线或囊袋感染 ,尽早采取外科清创手术 ,摘除被感染的整个起搏系统 ,选择对侧胸壁植入 ,埋置部位在胸大肌与胸小肌 ,术后 3个月内限制其活动。     

11例人工永久心脏起搏器置入术后随访分析

为探讨11例患儿安装永久起搏器后原发病改善情况、起搏器工作状况及术后的并发症，于术前，术后1周、1、3、6及12个月，此后每年复查心电图、胸片、心脏超声等检查；同时检测起搏器阈值，阈值结果采用t检验进行统计。结果显示术后临床症状及心电图、胸片、超声检查结果较术前改善；术中与术后1周、术后1周与1个月、1个月与3个月阈值比较有明显差异，术后3个月与1年、3年分别比较无明显差异；感染等并发症多见于术后3个月内。提示：术后原发病预后得到改善，起搏器起搏功能良好，阈值于术后3个月稳定；并发症于术后3个月内多见，在此期间应密切随访。     

临时心脏起搏器治疗阿-斯综合征9例

目的探讨临时心脏起搏器治疗阿-斯综合征(ASS)的价值。方法ASS患儿8例在X线透视下1例床边盲插起搏导管,安装临时心脏起搏器。结果7例于ASS发作1~2d安装,2例于ASS发作10d和20d安装。2例死亡,2例最终安装永久心脏起搏器;5例治愈。起搏过程中2例出现起搏电极移位,1例出现心脏杂音,1例出现局部皮肤感染。结论心脏临时起搏器抢救小儿ASS发作效果良好,且安装越早,预后越好。     

先天性完全性房室传导阻滞并发阿斯综合征安置心脏起搏器的探讨

本文报告２０年来专科门诊及住院诊治５６例先天性完全性房室传导阻滞（ＣＣＡＶＢ），初诊平均年龄４．２岁，其中２例伴室间隔缺损。５６例中２３例发生≥１次以上阿斯氏征，频发者１６例。发作时８例为缓慢心律（〈４０次／分），１３例为快速室速室主要为扭转型室速（Ｔｄｐ），２例不详，作者指出８６％发生于≤５岁，随着年龄增高而减少，ＱＴ间期延长，运动不耐受及低钾等均为促发因素。阿斯氏发作时不论缓慢或快速心率均应采     

心外膜永久性起搏器植入术治疗小儿严重缓慢型心律失常的疗效及随访分析

目的:探讨心外膜永久性起搏器植入治疗小儿严重缓慢型心律失常的疗效和经验。方法:收集2010年7月27日至2020年7月28日在广州市妇女儿童医疗中心接受永久性起搏器植入术的患儿共52例,其中男25例,女27例,年龄为338 d(143~1696 d ）,体重为7.3 kg(5.1~14.3 kg）。所有手术由同一组外科...     

125I粒子植入术在儿童头颈部横纹肌肉瘤的临床应用

目的：评价125I粒子植入术对儿童头颈部横纹肌肉瘤（RMS）的疗效及副作用。方法：以8例(男4例,女4例）头颈部RMS患儿的原发病灶为目标靶区植入125I放射性粒子,其中原发部位为眼睑及眼2例,眼眶4例,鼻腔及鼻翼2例。观察125I粒子植入术对病灶治疗的有效性及副作用。结果：8例患儿平均随访时间为45±17个月,中位随访时间为43个月,病情达到完全缓解5例,部分缓解2例,死亡1例,总生存率为88%（7/8）。植入术后8例（100%）患儿均出现局部色素沉着,其中1例出现角膜混浊,1例出现眼球胀痛,1例出现视力模糊加重,1例出现视力丧失,1例出现鼻腔黏膜破溃出血。除1例角膜混浊及1例视力丧失外,余6例相关副作用经过治疗均好转。结论：125I放射性粒子植入术治疗儿童头颈部RMS治疗价值肯定,虽存在局部副作用,但经对症治疗可缓解。     

儿童生长痛的临床探讨

生长性疼痛是一种原因不明的、发生在小儿生长最旺盛期之前的一种肢体痛症。我院 1993～ 2 0 0 0年诊断为儿童生长痛 15 8例 ,经临床治疗 ,效果较好 ,报道如下。临床资料一、对象　 15 8例中男 6 2例 ,女 96例 ,年龄 4～ 14ａ,平均 8.5ａ。肢体疼痛部位 :膝关节周围痛 12 0例 ,占 75 .8% ;髋关节及股骨上段痛 2 0例 ,占 12 .7% ,余 18例为小腿、足跟、股骨下段及臀部等部位疼痛占 8.7%。病史最长 2ａ ,最短 1周。血常规、血沉、类风湿因子、抗链“Ｏ”及肢体疼痛部位摄Ｘ线片 ,均正常。二、治疗　 1.嘱患儿减少活动量。 2 .补充维生素及钙剂…     

儿童起搏器植入治疗进展及若干问题思考

儿童心脏起搏器植入总量并不多,但却面临诸多问题.现有指南及植入方案大都基于成人经验,并不完全适用于儿童患者.诸如左束支起搏、无导线起搏器植入等新型植入方式及装置的儿童适应证也有待进一步探索.考虑到儿童生长发育的特性以及未来可能面临的数次起搏器升级、更换等情况,对于儿童起搏器的植入方式、起搏器导线植入部位、术后并发症的防...     

Myocardial scintigraphy after pacemaker implantation for congenital complete atrioventricular block

Patients with isolated congenital complete atrioventricular block (CCAVB) occasionally develop dilated cardiomyopathy (DCM), despite early pacemaker implantation. However, the etiology of the DCM and its relationship to permanent ventricular pacing are not fully understood. Twenty-five patients with CCAVB underwent ^99m technetium (Tc) myocardial perfusion scintigraphy. Five patients were studied before and after pacing, providing a total of 30 image sets, which were divided into three groups; group 1: CCAVB before pacemaker implantation (PMI) (n = 11); group 2: CCAVB after PMI who did not subsequently develop DCM (n = 13); group 3: CCAVB after PMI who subsequently developed DCM (n = 6). Perfusion defects on single-photon-emission computed tomography (SPECT) were identified in group 1, 0 of 11 patients; group 2, 85% of patients; and group 3, 100% of patients. In groups 2 and 3, in patients with right ventricular pacing, the perfusion defects were mainly in the septum or between the apex and septum. On 20 segments’ polar maps, the distribution of %uptake showed a similar pattern in groups 2 and 3, the degree of decreased %uptake and the number of segments with decreased %uptake being more severe in group 3. “Artificial” left bundle branch block (LBBB) pattern myocardial contraction induced by right ventricular pacing decreased myocardial perfusion around the apex and septum. Some patients with CCAVB will develop left ventricular dysfunction caused by artificial LBBB-induced interventricular asynchrony.     

A pacemaker for asystole in breath-holding spells

Two cases of young children with frequent severe breath-holding spells complicated by prolonged asystole and seizures are reported. A ventricular pacemaker was implanted in each child, and both have subsequently remained free of syncope, although they continue to exhibit breath-holding behaviour.     

儿童永久起搏器电池更换术后切口愈合不良两种治疗方案的对比研究

目的对比儿童永久起搏器电池更换术后切口愈合不良两种不同治疗方式的疗效。方法回顾性分析2001年1月至2019年11月行起搏器电池更换后出现切口愈合不良的11例患儿病历资料,其中男童7例,女童4例,平均年龄(7.3±2.5)岁,电池更换距离上一次起搏器电池植入时间(4.1±1.5)年,7例切口有脓性分泌物,4例有清亮分泌物。8例于术后3周内再次入院,3例分别于术后45 d、40 d、32 d再次入院。5例有低热症状,6例无发热症状。依据不同治疗方式分为手术组(n=6)和常规换药组(n=5)。手术组1例予囊袋扩大后清创缝合,5例予原囊袋切除清创缝合。常规换药组5例均予以头孢菌素或万古霉素抗感染,治疗碘伏纱布每日换药2次,其中2例予持续负压吸引2周。结果手术组6例患儿均在术后2周内痊愈出院,平均住院时间(11±3)d,均在术后3 d内拔除引流管,平均引流量(25.6±10.1)mL,术后电话随访,未再发生切口愈合不良。手术组6例患儿均未发生全身感染及感染性心内膜炎,伤口愈合良好,疗效满意。常规换药组平均住院时间(30±5)d,1例出院2个月后再次入院,拆除原腹部起搏器,更换为心内膜起搏器。两组患儿住院时间具有统计学差异(t=-9.6,P<0.01)。出院前手术组和常规换药组C反应蛋白测量值分别为(8.2±2.5)mg/L和(25.0±15.0)mg/L,差异有统计学意义(t=-2.8,P<0.05)。结论儿童永久起搏器电池更换术后切口愈合不良发生后,将原起搏器囊袋切除,减少异物植入,可吸收线间断缝合,适当游离皮片减少吻合口张力,可取得满意疗效。此方法与常规换药相比可明显缩短住院时间,减轻病人痛苦,降低再次感染的发生率。     

Implantable cardioverter defibrillator implantation in children in The Netherlands

To evaluate the indications, underlying cardiac disorders, efficacy and complications involved with implantable cardioverter-defibrillators (ICDs) in paediatric patients in The Netherlands, the records of all patients aged 18 years or younger who underwent ICD placement were reviewed retrospectively. Between January 1995 and September 2002, 23 patients (11 males, 12 females; median age 12 years, range 6 months to 16 years) underwent ICD implantation. The ICD was implanted for aborted sudden cardiac death ( n =14), syncope ( n =5) or for primary prevention of sudden cardiac death ( n =4). Underlying cardiac disorders were electrical diseases ( n =16), hypertrophic or dilated cardiomyopathy ( n =4) and congenital cardiac malformations ( n =3). Five patients had an epicardially placed ICD, while 18 underwent a transvenous approach. The generator was placed in an abdominal position in eight patients, whereas it was placed in the subpectoral region in 15. There was no early mortality. Median hospital stay was 5 days (range 2–30 days). Median follow-up time was 29 months (range 1 month to 7 years). Seven patients experienced an inappropriate shock after a median period of 7 months; five patients an appropriate shock after a median period of 3 months. The reasons for inappropriate shock were supraventricular tachycardia ( n =1), sinus tachycardia ( n =4) or T-wave sensing ( n =2). One patient with malignant long QT syndrome died of intractable arrhythmias and irreversible cardiomyopathy. Generator replacement was necessary in four patients after 28, 44, 51 and 54 months respectively. Conclusion:Implantable cardioverter-defibrillator implantation in paediatric patients is a safe procedure with a good medium-term outcome. The most serious problem is the occurrence of a significant number of inappropriate shocks.     

房室传导阻滞的起搏治疗

心脏起搏治疗各种原因导致的儿童完全性房室传导阻滞,使该类儿童患者寿命明显提高,已逐渐被儿科医生和患儿家长所接受.对于儿童起搏器植入的适应证、起搏电极的植入路径和位置的选择成为关注热点,相关指南和专家共识在不断更新.最新专家共识推荐心内膜起搏电极植入位置为右室间隔,心外膜起搏电极为左室,可避免由于长期右室心尖起搏左右心室不同步导致的心功能不全.     

儿童永久起搏器植入术围手术期心肌损伤及心功能改变的研究

目的 探讨儿童永久起搏器植入术围手术期心肌损伤及心功能改变.方法 回顾分析2018年11月至2019年10月收治的因各类心动过缓行永久起搏器植入术患儿的临床资料,比较起搏器植入术前、术后1天、术后1周患儿血肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽原(NT-proBNP),以及术前与术后1周...     

Sinus node dysfunction in children and adolescents: treatment by implantation of a permanent pacemaker in 26 patients

Sinus node dysfunction has been reported rarely in pediatric patients with structurally normal hearts. It has been diagnosed with increasing frequency in children and young adult patients with congenital heart defect, especially in patients who have undergone corrective cardiac surgery related with atrial tissue. Between 1984-1999, 26 patients who were under 22 years of age underwent implantation of a permanent pacemaker for treatment of sinus node dysfunction at our medical center. This subset of patients represents 18.5% of all patients who required permanent pacemakers during this time. The mean age of the 17 male and 9 female patients at initial implantation was 9.2+/-6 years (range, 0.5 to 22 years). Of the 26 patients, 18 (69%) had associated cardiovascular disease and in 11 (34.6%) patients, sinus node dysfunction developed after a cardiac operation. The patients were followed up for a total 1,227 (47+/-45, range 2-176, median 34) pacing months. All symptomatic patients noted a resolution of symptoms after pacing had been performed, and they remained free of symptoms at the latest follow-up examination. Mean acute pacing thresholds and mean latest pacing thresholds for the endocardial atrial and ventricular leads, mean acute impedance and mean latest impedance for the endocardial atrial and ventricular leads and mean acute p wave voltage and the latest p wave voltage did not differ significantly. In this report, we review our experience in children who required implantation of a permanent pacemaker for treatment of sinus node dysfunction during a 15-year period.     

Dilated cardiomyopathy after pacemaker implantation in complete heart block

BACKGROUND: The aim of this study was to evaluate the clinical features of patients with congenital complete heart block (CCHB) who developed dilated cardiomyopathy (DCM) after pacemaker implantation (PMI) and to determine factors predicting DCM development. METHOD: A total of 15 patients were reviewed retrospectively. They were classified into two groups, one consisted of four patients who were diagnosed as having CCHB in utero or at birth and who developed DCM after PMI (DCM group) and the other consisted of 11 patients who did not (non-DCM group). RESULTS: Maternal autoantibodies were found in two of the DCM group and in five of the non-DCM group. Perfusion defects in myocardial imaging were detected in all DCM patients and in five non-DCM patients. DCM developed 2 to 43 months after PMI and three DCM patients died of heart failure 7 to 48 months after PMI. In pathological studies, endocardial or interstitial fibrosis was present in all DCM patients and in one of two in the non-DCM group. No significant differences between the two groups were found in age at PMI, atrial or ventricular rate, end-diastolic dimension and ejection fraction of the left ventricle before PMI, and width of QRS after PMI. CONCLUSION: Although it was suspected that the patients with CCHB had myocardial involvement before PMI, there was no significant factor predicting the risk of DCM after PMI. In addition to cardiac rhythm abnormalities, careful attention should be paid to cardiac function in CCHB patients after PMI.