经头静脉放置起搏电极导线手术方式的改进及临床意义

目的探索经胸横切口暴露头静脉及使用导引钢丝、静脉鞘管引导放置起搏电极导线的成功率及临床意义.方法 220例具备起搏治疗指征的病人,在右上外侧胸部做横切口分离头静脉,当经该静脉直接送入起搏电极导线有困难时,在导引钢丝及静脉鞘管的引导下送入电极导线.如果经以上方法均不能顺利放置电极导线,则经切口内穿刺锁骨下静脉送入电极导线.起搏器埋藏在头静脉切口内侧的皮下囊袋内.结果横切口同样能良好地暴露头静脉.此外,当需要经锁骨下静脉穿刺时,直接经该切口内穿刺不但方便,而且减少创伤.直接经头静脉放置单腔及双腔起搏器电极导线的成功率分别为71%及58%,加用导引钢丝及静脉鞘管后成功率分别提高到94%及88%(P值均<0.01).结论经胸做横切口分离头静脉结合使用导引钢丝及静脉鞘管技术可显著性提高经头静脉放置起搏电极的成功率,减少锁骨下静脉穿刺及相应的并发症,并方便起搏器的放置.     

起搏器植入术常见并发症分析

目的探讨起搏器植入术常见的并发症及防治方法。方法男188例，女122例，年龄22～85岁。310例起搏器中单腔起搏器94例，双腔起搏器216例，分析并发症的发生原因。结果共发生起搏器相关并发症25例，术后常见的并发症分别是囊袋血肿7例、电极导线脱位4例、囊袋破溃及感染9例，起搏器综合征5例。囊袋血肿的发生与术前使用阿司匹林有关，电极导线脱位、囊袋破溃及感染等大部分与手术有关，起搏器综合征与VVI起搏模式有关。结论加深对起搏器常见并发症的了解、提高鉴别能力、重视术前预防，术中规范操作和加强术后随访，可将起搏器并发症降低到低限。     

永久起搏器植入常见并发症及防治措施

目的 回顾性分析710例永久起搏器植入术并发症的发生率及原因,以提高起搏器植入技术的安全性和有效性.方法 连续选择2005年1月至2010年6月在我院行永久起搏器植入术的患者710例,随访0.5 ～6年,观察并发症的发生率及原因.结果 起搏器植入常见的并发症分别是囊袋内积血及血肿（n=10,1.41％）、电极导线移位（n=8,1.25％）、起搏阈值升高（n=6,0.93％）及囊袋侵蚀（n=2,0.28％）.出血的发生与年龄偏大有关;电极导线的脱位主要是电极导线固定不良所致;囊袋侵蚀与患者体型偏瘦、囊袋制作偏小,或与原起搏器形状不相称引起皮肤受压缺血有关.结论 随着技术熟练及采取相应措施,可以减少并发症发生.     

起搏器植入术罕见并发症1例

随着起搏器植入手术技术的日益成熟,心脏永久起搏器植入已成为治疗严重缓慢性心律失常（房室传导阻滞、症状性病态窦房结综合征等）的标准疗法。自1958年世界首例埋藏式心脏起搏器植入人体后,起搏器植入技术飞速发展,经静脉导线植入是目前起搏技术的核心手段。虽然越来越多的心律失常患者得到及时救治,但是相关的并发症却一直困扰着临床医师。有研究报道,植入传统起搏器患者中,9.2%出现起搏阈值不良、起搏导线脱位、感染等长期并发症,9.5%～12.6%出现导线相关囊袋血肿和气胸等短期并发症。本病例为起搏器植入术罕见并发症,实应引以为戒。     

256例永久起搏器植入术后并发症的分析

目的：分析256例永久起搏器植入术后并发症发生的原因及防治。方法：收集256例永久性起搏器植入患者的临床资料进行回顾性分析。结果：发生起搏器术后并发症共28例,其中囊袋血肿12例,囊袋破溃感染2例,电极导线脱位2例,起搏综合征4例,心外肌肉收缩2例,精神神经症状3例,起搏器介导心动过速3例。结论：提高起搏器并发症早期识别能力并及时处理,完善术前准备,术中规范操作,术后定期随访及加强对患者的宣教,可降低并发症的发生率。     

心脏起搏器术后并发症的分析及处理

目的 分析永久性心脏起搏器置入术后并发症的原因及处理方法.方法 回顾性分析325例心脏起搏器置入术后出现并发症患者的临床资料.结果 发生起搏相关的并发症包括囊袋血肿8例,电极穿孔2例,电极导线脱位4例,起搏器综合征3例,深静脉血栓3例,BackupVVI起搏1例,导线断裂1例.结论 充分认识起搏相关的各种并发症,重视术...     

116例永久起搏器植入术后并发症的分析

目的分析116例永久起搏器植入术后并发症发生的原因,探讨处理方法和减少并发症的策略。方法对2003年1月~2006年10月本院安装的116例永久起搏器患者临床资料进行回顾性分析。结果发生起搏器并发症共18例,术中严重心律失常发生1例,术后并发症发生17例,其中囊袋内积血及血肿9例,囊袋皮肤溃破起搏器外露1例,电极导线脱位2例,电极导线断裂2例,起搏介导性心律失常(PMT)1例,起搏综合征2例。结论提高起搏器并发症早期识别能力并及时处理,完善术前准备,术中规范操作,术后定期随访及加强对患者的宣教,可降低并发症的发生率。     

462例永久起搏器置入术并发症的相关因素分析及防治对策

分析 4 6 2例永久起搏器置入术发生的并发症原因 ,以利减少其发生率。选择 1995年 3月～ 2 0 0 3年 12月因缓慢或快速心律失常置入起搏器或自动复律器 (ICD)的患者 4 6 2例。其中男 2 2 4例 ,女 2 38例 ;缓慢性心律失常4 4 8例、快速性心律失常 (室性心动过速或心室颤动 ) 14例 ;4 6 2例起搏器中单腔起搏器 2 4 1例、双腔起搏器 2 0 7例(包括部分双室起搏 )、三腔起搏器及ICD 14例。术后常见的并发症分别是囊袋内积血及血肿 (6 .1% )、电极导线脱位 (1.5 % )、囊袋破溃及感染 (1.1% ) ,积血的发生与年龄偏大和术后使用阿司匹林有关 ,电极导线的脱位主要是固定的、结扎线松开 ,电极导线固定不良所致 ;感染的发生主要在慢性期 ,尤其是更换起搏器的患者 ,考虑囊袋制作偏小、或与原起搏器形状不相称引起皮肤受压缺血 ,激发无菌性炎症 ,破溃后发生细菌性感染是其主要原因。结论 :采取相应措施 ,可以减少此类并发症。     

永久起搏器并发症的临床分析

目的 观察植入永久性心脏起搏器的并发症情况,寻找其原因,并探讨其防治策略.方法 对382例植入或更换起搏器出现并发症患者的临床资料进行回顾性分析.结果 并发症情况：囊袋血肿15例,电极脱位8例,电极断裂2例,囊袋破溃并（或）感染4例,感知不良6例,起搏器综合征5例,弄摆综合征1例,静脉血栓形成1例.结论 应加强对植入起搏器常见并发症的认识,严格术中规范操作,加强术后随访,尽可能将并发症降到最低.     

头静脉途径心脏起搏器植入术中撕剥式导线导引器的应用价值

目的 探讨撕剥式导线导引器在经头静脉途径心脏起搏器植入术中的应用价值. 方法 183例经头静脉途径心脏起搏器植入术患者根据导线置入时是否应用撕剥式导线导引器分为改良组（n=91）和常规组（n=92）.比较两组手术时间、X线曝光时间、导线放置成功率、手术并发症. 结果改良组头静脉导线放置成功率97.80%.明显优于常规组80.43%（P〈0.01）.双腔起搏器植入者双导线放置成功率64.62%,明显优于常规组的26.56%（P〈0.01）.改良组手术时间、X线曝光时间分别为（61.13±12.03）min、（5.77±1.35）min.与常规组（62.22±13.26）min、（5.89±1.43）min相似（均P〉0.05）.两组各有1例术后囊袋血肿,随访3个月-2.5年未见其他并发症.结论 经头静脉途径植入心脏起搏器时,撕剥式导线导引器能明显提高导线放置成功率.     

双心腔主动电极起搏与心房被动心室主动电极起搏的对比研究

目的:观察心房心室双螺旋主动电极在双腔心脏起搏器植入术中的有效性和安全性。方法:回顾性将90例符合双腔起搏器植入指征的患者分为心房心室双螺旋主动电极组(双螺旋电极组42例)与心房被动电极、心室螺旋主动电极组(单螺旋电极组48例)。观察2组术中及术后随访情况。结果:2组均成功植入起搏器及起搏电极。双螺旋电极组中1例孕妇零射线下完成双螺旋电极及起搏器植入;4例永存左上腔静脉患者在左侧锁骨下完成双螺旋电极及起搏器植入。双螺旋电极组和单螺旋电极组的手术时间及射线时间无显著差别,双螺旋电极组术后卧床时间显著缩短[(4.2±1.5)h vs(56.3±22.5)h,P0.05]。单螺旋电极组术中出现心房电极导线脱位3例,双螺旋电极组未见导线移位、心肌穿孔及心包填塞等情况。术后随访,2组均无电极脱落和起搏阈值升高。结论:心房心室双螺旋主动电极在双腔心脏起搏器植入术中安全可行,并不增加手术时间和射线时间,特别是应用于心腔结构异常和特殊患者,显著增加手术成功率。     

29例起搏器和置入式心脏复律除颤器导线断裂的临床分析

目的分析心脏起搏器和置入式心脏复律除颤器(ICD)导线断裂可能的原因、部位和处理方法。方法回顾性分析1982年1月至2004年11月置入的永久起搏器和ICD,通过随访症状、程控测试、检查X线胸片及心电图,及时发现导线断裂,给予相应处理,并随访观察疗效。结果分析置入的起搏器4698台和ICD161台,共发现导线断裂29例、导线31支,发生率0.6%;其中经锁骨下静脉置入组导线断裂发生率0.9%,头静脉置入组0.4%,P=0.04。断裂部位锁骨下22例,囊袋内6例,心室内1例。29例患者中,24例置入新导线。3例心房导线断裂,将起搏器由DDD程控为VVI工作方式。处理后平均随访(55.6±16.1)个月。1例因保留的断裂导线露出皮肤,引发感染,开胸取出导线。结论起搏器和ICD导线置入应首选头静脉切开途径,其次选择经锁骨下静脉外侧端穿刺置管。导线断裂部位主要发生在锁骨下,定期复查可以及时发现导线断裂,妥善处理。     

置入双腔起搏心脏复律除颤器及经腋静脉送入心内电极的初步临床体会

目的初步评价新型双脏起搏心脏复律除颤器抗室性心动过速／心室颤动（室速／室颤）及心动过缓起搏的临床效果,了解经腋静脉送人心房及心室电极的安全性及有效性。方法７例室速及（或）室颤同时伴有心动过缓患者接受了双腔起搏心脏复律除颤器治疗,其中冠心病５例、扩张性心肌病２例。心房及心室电极均在Ｘ线透视、静脉注人造影剂指导下,直接穿刺腋静脉,从该静脉送人。结果脉冲发生器埋在左上胸皮下５例,埋在胸大肌与胸小肌之间２例。仪器对所有室速／室颤均能及时识别并成功治疗,同时提供有效的房室顺序起搏功能。所有心内电极均成功地经腋静脉送人,无并发症。结论双腔起搏心脏复律除颤器不但能有效地治疗严重室性心律失常,而且提供可靠的房室顺序性起搏功能。经腋静脉送入电极安全、可靠。     

Early complications of permanent pacemaker implantation: no difference between dual and single chamber systems.

OBJECTIVE--To evaluate the incidence of intraoperative and early postoperative complications (up to two months after implant) of endocardial permanent pacemaker insertion in all patients under-going a first implant at a referral centre. METHODS--Prospective evaluation of all endocardial pacemaker implantation procedures performed from April 1992 to January 1994 carried out by completion of standard audit form at implant. Patients' demographic data, medical history, details of pacemaker hardware used, and any complications were noted. Follow up information was also collected prospectively onto standard forms at pacemaker outpatient clinic. SETTING--United Kingdom tertiary referral cardiothoracic centre. PATIENTS--1088 consecutive patients underwent implantation of their first endocardial permanent pacemaker from April 1992 to January 1994. Implant and follow up data were available for 1059 (97.3%) patients at analysis. The median (range) age was 77 years (16-99); 51.2 % were male. RESULTS--Dual chamber units were implanted in 54.1% of patients, single chamber atrial in 5.2%, and ventricular in 40.7%. A temporary pacing lead was present at implant in 22.9% of patients. Most (93.6%) implants were performed via the subclavian vein. Immediate complications were rare: eight (0.8%) patients developed pneumothorax requiring medical treatment and 11 (1.0%) an insignificant pneumothorax. There was no significant difference in the pneumothorax rate for dual chamber (DDD) compared with single chamber systems. Arterial puncture without sequelae was documented in 2.7% of attempts at subclavian vein cannulation. A total of 35 patients (3.3%) required reoperation; the reoperation rate for dual chamber (3.5%) was similar to that for single chamber (3.1%) systems. Electrode displacement (n = 15, 1.4%) was the most common reason for reoperation. Atrial lead displacement (n = 10, 1.6% of atrial leads) was significantly more common than ventricular lead displacement (n = 5, 0.5% of ventricular leads, P = 0.047). There was no difference in electrode displacement rates for dual (1.6%) compared with single (1.2%) chamber systems. Pacemaker pocket infection led to reoperation in 10 patients (six dual, four single chamber, P = not significant) and was significantly more common in patients who had a temporary pacing lead in place at implant (2.9%) than in those who did not (0.4%, P = 0.0014). Five patients (0.5%) required reoperation for generator erosion (two dual, three single chamber, P = not significant). and a further five for drainage of haematoma or a serous fluid collection (three dual, two single chamber, P = not significant). Complications that did not require reoperation were also rare. Undersensing occurred in 10 patients (0.9%). Atrial undersensing (n = 8) was significantly more common than ventricular undersensing (n = 2, P = 0.017). All patients were successfully treated by reprogramming of sensitivity. Superficial wound infection was treated successfully with antibiotics in nine patients (six dual, three single chamber, P = not significant). Three patients with DDD generators developed sustained atrial fibrillation: two required reprogramming to VVI mode and one required cardioversion. CONCLUSIONS--Permanent pacing in a large tertiary referral centre with experienced operators carries a low risk. Infection rates are low, < 1% overall but significantly higher in patients who undergo temporary pacing before implantation. Lead displacement and undersensing are more likely to occur with atrial than ventricular leads. The overall complication rate for dual chamber pacing, however, is no higher than for single chamber pacing.     

Acute and early complications of permanent pacing: A prospective audit of 926 consecutive patients from a UK center

To evaluate the incidence of intraoperative and early postoperative complications (up to 2 months after implant) of endocardial permanent pacemaker insertion in all patients undergoing their first implant at our Center, we prospectively evaluated all pacemaker implantation procedures performed from April 1992 to September 1993. A standard audit form was completed at implant, recording patient demographic data, medical history, details of pacemaker hardware used, and any acute complications. Follow-up information was also collected prospectively onto standard forms at the pacemaker outpatient clinic. The study was performed in a United Kingdom tertiary referral Cardiothoracic Center. Nine hundred and fifty consecutive patients underwent implantation of their first endocardial permanent pacemaker from April 1992 to September 1993. Implant and follow-up data to 2 months were available on 926 (97.5%) of these patients at analysis, 51.4% were male (median age 77 years; range 16–99). Dual chamber units were implanted in 53% of patients, single chamber atrial in 6%, and ventricular in 41%. At implant, 23% of patients had a temporary pacing leadin situ. Most (93%) implants were performed via the subclavian vein. Acute complications were rare: 9 patients developed pneumothorax requiring medical treatment and 10 patients developed an insignificant pneumothorax. Arterial puncture without sequelae was documented in 2.7% of attempts at subclavian vein cannulation. Complications requiring re-operation occurred in 3.5% of patients overall; lead displacement [n=14 patients (1.5%)] was the most common reason for re-operation. Atrial lead displacement [n=10 patients (1.85% of atrial leads)] was significantly more common than ventricular lead displacement [n=4 patients (0.46% of ventricular leads),p=0.02]. Pacemaker pocket infection led to reoperation in 9 patients (0.97%) and was significantly more common in patients with a temporary pacing lead at implant (2.35%) compared with those without (0.56%,p<0.05). Five patients (0.5%) required re-operation for generator erosion and a further 5 (0.5%) for drainage of hematoma or a serous fluid collection. Complications that did not require re-operation occurred in 2.4% of patients overall: atrial (n =8) and ventricular (n=1) undersensing was successfully treated by reprogramming of sensitivity in all cases. Superficial wound infection was treated successfully with antibiotics in eight patients. Six patients with DDD generators developed atrial fibrillation: one was cardioverted, two required reprogramming to VVI mode, and three reverted spontaneously to sinus rhythm. In summary, permanent pacing in a large tertiary referral center with experienced operators carries a low risk. Infection rates are low (<1%). Lead displacement and undersensing are more likely to occur with atrial than with ventricular leads. The overall complication rate for dual chamber pacing is no higher than for single chamber pacing.Presented at the 36th Annual World Congress, International College of Angiology, New York, New York, July 1994