起搏器植入术后囊袋感染并发阿斯综合征1例报告

<正>1例患者因"病态窦房结综合征"行DDD起搏器植入术,术后患者出现起搏器排斥反应,先后多次予起搏器手术伤口清创及重置术,后患者反复出现感染性心内膜炎,根据药敏试验多次予抗生素治疗后好转。患者近期突发晕厥,发作时心电图提示无效起搏波,明确为阿斯综合征发作,行胸片排除起     

植入心内膜电极后心脏局部形态和组织学变化——附一例报告

植入永久性心内膜起搏电极后,心脏局部形态和组织学有何变化,以及与此变化有关的电极脱位、阈值升高、感染等并发症是临床医生颇为关注的问题。本文报告一例永久性右室起搏病人的心脏病理检查结果,并作简要讨论。 一 般 资 料 患者,男,14岁。因病毒性心肌炎、Ⅰ度房室传导阻滞、反复发作阿斯综合征,于1977年12月安置右心室心内膜单极电极行永久性心脏起搏治疗。     

经胸壁穿刺直接心脏起搏在心脏急症中的应用

临时起搏器的临床应用,挽救了大批因心脏停搏,重度房室传导阻滞造成阿斯综合征发作的病人。由于穿刺部位的不同,起搏成功所需的时间不一。如经静脉心内膜起搏,经食管心房起搏,经胸壁穿刺直接心脏起搏等,以后者最快捷。本文     

临时起搏抢救高度(和完全性)房室传导阻滞二例报告

各种原因引起的高度或完全性房室传导阻滞,常发生急性心源性脑缺血综合征,其死亡率极高。对这类病人必须进行积极的抢救,但往往药物治疗难以凑效,安置心脏起搏器是治疗该病的一项有效措施。在危急的情况下或一些不需长期起搏的患者给予临时起搏常可收到预期效果,使病者转危为安。近年来,我们用临时起搏(用双电极导管由静脉插入至右心室近心尖部,另端引出体外连接上海 AXQ—1型携带式R—抑制型按需心脏起搏器),抢救了2例因冠心病致高度和完全性房室传导阻滞倂发急性心源性脑缺血综合征或头晕,经人工起搏后(1例安置4天,1例为     

人工心脏起搏器安装1例报告

人工心脏起搏器用于起搏或传导系统功能有障碍的心脏。我科为一72岁女患，患有严重高血压病、1．度房室传导阻滞、反复发生阿斯氏综合征的病人，成功地安装了按需型起搏器，取得了预期效果，现报告如下：1病历摘要来XX，女，72岁。因胸闷、气短、呼吸困难30余年入院。30余年发现血压高，最高达28／14．7kPa，出现发作性晕厥23年，每次几分钟至半小时，心率经常在20次／min左右，最低时只有7次／min，故需经常静点阿托品及异丙肾来维持生命，心率用药后可230次／min，心电图为完全性房室传导阻滞、伴房颤，心室率只25次／min。患者呼吸困难…     

甲状腺机能亢进并发完全性房室传导阻滞及阿—斯综合征一例报告

文献报道2～30%的甲状腺机能亢进(以下简称甲亢)患者可发生第一度房室传导阻滞,并发完全性房室传导阻滞者较为罕见。国外 Davis 等报道6例发生不同感染的甲亢患者出现完全性房室传导阻滞。国内陶氏在1954年报告1例甲亢并发阿——斯综合征,但其发生原因又并非由于完全性房室传导阻滞所致。邓氏在1961年报道5例。现将我院所见1例报告如下。     

9例小儿完全性房室传导阻滞的治疗及预后

完全性房室传导阻滞在小儿心脏房室传导阻滞中占小部分 ,但病情凶险 ,死亡率高。本文总结我院近十年来收治的由病毒性心肌炎引起的完全性房室传导阻滞 9例 ,现就其治疗及预后探讨如下。临　床　资　料1　一般资料　　本组 9例 ,男 6例 ,女 3例 ;年龄最小 2岁 9个月 ,最大 1 1岁 ,平均 5岁 6个月。2　病因　　均符合病毒性心肌炎诊断标准[1] 。3　临床表现　　病程中均有不同程度的发热、心慌、胸闷、乏力等 ,从出现上述症状到确诊完全性房室传导阻滞 8小时至 9天。确诊前均出现过晕厥、意识丧失、或伴抽搐 (阿斯综合征 )。其中 5例因晕厥就…     

三度房室传导阻滞148例分析

三度房室传导阻滞(Ⅲ°AVB),常可引起严重的血流动力学障碍而发生阿斯综合征,甚至危及患者的生命,在临床上并非少见。本文对1972年以来经心电图检查按黄氏标准诊断的148例Ⅲ°AVB患者之病因,阿斯综合征发作因素、治疗及预后作一简要分析。     

急性下壁心肌梗塞引起高度房室阻滞 临床装置(人工心脏起搏)对其预后的意义(附144例的观察)

据报告急性心肌梗塞病例中有12～25％房室传导阻滞(以下简称房阻),各种房阻的发生在急性下壁心肌梗塞(IMI)时,较前壁心肌梗塞多二至四倍、当急性(IMI)时传导阻滞经常位于房室结,可能适当的近端闭塞是来自房室结动脉,因其在90％病例是从右冠状动脉分枝而来。急性(IMI)以及下列各种症状是被建议应用心脏起搏治疗:阿斯氏征发作,心力衰弱(充血性心力衰竭或休克),以及室性心律不齐引起的心动过     

AAI起搏患者远期心房电极移位和房室传导功能变化及其对AAI起搏的影响

目的:了解AAI起搏治疗下病态窦房结综合征患者远期心房电极移位和房室传导阻滞的发生及对AAI起搏的影响。方法:观察比较30例AAI起搏患者48～72个月后双结功能电生理参数和心房电极位置的变化。结果:AAI起搏治疗下病态窦房结综合征患者远期房室传导文氏阻滞点及2:1阻滞点与术前比较均无显著统计学差异(P>0.05),4例电极移位(12.5％)HOLTER随访均起搏和感知功能良好。结论:远期心房电极移位不影响AAI起搏治疗,AAI起搏下病态窦房结综合征患者房室传导功能的改变对AAI起搏无影响。     

40例安置永久性心脏起搏器临床分析

我院自1982年以来,安置永久性心脏起搏器40例,主要病因:冠心病.临床表现:头昏,晕厥,黑朦,阿斯综合症.EKG:窦性停搏、窦性心动过缓、Ⅱ度房宣传导阻滞,Ⅲ度房室传导阻滞,常见的并发症:局部感染、皮下囊血肿、电极脱位.本文对临床分析和并发症的治疗进行探讨.     

起搏器治疗急性心脑缺氧综合征30例临床分析

本文报告应用起搏器治疗30例急性心脑缺氧综合征,均取得了较满意的效果。作者结合本组病例讨论了对安置起搏器常见并发症的防治体会,并对起搏器性能作了比较,结果表明,秦明公司Pinnacle 8619型是目前国内较理想的埋藏式起搏器。     

永久性心脏起搏器植入280例远期并发症分析

目的:探讨永久性心脏起搏器植入术后远期并发症类型及处理方法。方法:植入永久起搏器患者280例,术后随访≥2年,统计植入术2年后远期并发症发生情况。结果:280例患者发生远期并发症共17例,总发生率6.07%。其中≥60岁组13例,发生率6.34%;<60岁组4例,发生率5.33%,2组差异无统计学意义（P>0.05）。患者并发症中包括相关静脉血栓6例（2.14%）、起搏导线血栓形成4例（1.43%）、电极脱位3例（1.07%）、囊袋破溃感染2例（0.71%）、起搏综合征及起搏阈值明显升高致起搏不良各1例（0.36%）。结论:血栓、电极脱位和囊袋破溃感染在≥60岁患者中的发生率有升高趋势。应重视起搏器植入术前准备,术中强调规范的无菌操作,术后加强随访,早期发现并发症并积极处理。     

A Case of Transvenous Pacemaker Implantation in a 10-year-old Patient

Objective: The aim of this report was to discuss the type, timing, and surgical techniques of permanent pacemaker implantation in a juvenile patient.Patients: A 17-year-old girl with Down syndrome and congenital heart defects comprised of ventricular septal defects (VSD) and patent ductus arteriosus (PDA) suffered from postoperative complete atrioventricular block (AVB) when she was 7 months old.Methods and Results: An epicardial pacemaker was implanted just after the occurrence of complete AVB. Due to the pacing threshold of a ventricular lead not being good, the battery showed rapid depletion. Her generator had to be exchanged under general anesthesia every 2–3 years. When she was 10 years old, we implanted a permanent pacemaker transvenously by using cutdown, screw-in and subpectoral pocket techniques. She has shown a satisfactory outcome since then.Conclusion: Transvenous pacemaker implantation was safe and effective in our young patient without any complications. The timing of surgery and surgical technique are quite important for pacemaker implantation in juvenile patients.     

214例老年缓慢性心律失常植入心脏起搏器治疗的临床观察

目的 观察不同年龄段的老年患者在治疗缓慢性心律失常时植入心脏起搏器的临床特征。方法 选取2019年1月—2021年12月在内蒙古医科大学附属医院接受心脏永久起搏器植入治疗的214例缓慢性心律失常老年患者为研究对象,根据年龄不同分为60～69岁组（60例）、70～80岁组（82例）、> 80岁组（72例）。对比３组患者首发症状、起搏器植入病因、起搏器类型及随访电极参数。结果 所有入选者首发症状以黑蒙、晕厥为主（33.64%）。不同年龄组首发症状比较,差异无统计学意义（P >0.05）;老年女性乏力比例高于男性（P <0.05）。植入起搏器的病因依次为：病态窦房结综合征（以下简称病窦）79例（36.92%）、房室传导阻滞（AVB）78例（36.44%）、心房颤动（以下简称房颤）合并长间歇34例（15.89%）、双结病变23例（10.75%）。60～69岁组、70～80岁组病窦的占比均高于>80岁组（P <0.05）,而>80岁组房颤合并长间歇占比高于其他两组（P <0.05）。老年女性病窦的占比高于男性,而男性Ⅱ度Ⅱ型AVB的占比高于女性（P <0.05）。起搏器植入类型以双腔为主体（185例,86.45%）,>80岁组单腔起搏器植入数量高于70～80岁组（P <0.05）;术后7、90 d各组患者电极阈值和阻抗较术中均下降（P <0.05）,术后7 d与术后90 d比较,差异无统计学意义（P >0.05）。各组患者相同时间点各个电极参数比较,差异无统计学意义（P >0.05）。结论 接受心脏永久起搏器治疗的缓慢性心律失常老年患者的临床特征具有年龄和性别差异。通过短期随访,不同年龄的老年患者右心室中低位间隔固定电极均安全有效。     

心内起搏成功地抢救急性心肌梗塞合并Ⅲ°房室传导阻滞一例报告

<正> 急性心肌梗塞出现房室传导阻滞的发生率约10～15％;发生Ⅲ°房室传导阻滞者2.7～8％。关于急性心肌梗塞时发生完全性房室传导阻滞的病死率各家报告不同,Lown为47～80％,Gregory为30～70％,为47～85.7％,Friedberg约介于22～100％     

Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications

This report reviews the experience of permanent pacemaker insertion in a district general hospital (catchment population of 350 000) and makes a comparison with the national database and other hospitals in the UK.
METHODS—The records of all patients receiving a permanent pacemaker in the inclusive period January 1996 to December 1998 were reviewed. Data collected included number of patients paced each year, age, sex, indications, and complications.
RESULTS—In the three years reviewed 200 patients received new permanent pacemakers, a rate of 190 per million population per year, which is similar to the national implantation rate of permanent pacemakers but lower than that of most European countries (see discussion). The majority of patients paced were elderly (75% were above the age of 70 years).
Atrioventricular block (including complete heart block, 45%, and Mobitz type 2 block, 12.5%) was the commonest indication for permanent pacemaker insertion, followed by sick sinus syndrome (25%) and these findings are comparable to those reported previously. However, carotid sinus syndrome was responsible for 16% of the patients paced and this was higher than that reported in the national database (6.5%). Only 1% of the pacemaker modes used was inappropriate and the complication rate was low at 3%.
CONCLUSIONS—This report confirms that permanent pacemaker insertion can be effectively and safely provided locally for the increasingly ageing population. The implantation rate both locally and nationally is still much lower than that of some countries in Europe.


     

RIGHT BUNDLE BRANCH BLOCK WITH MARKED LEFT AXIS DEVIATION

Right bundle branch bloc-k associatedl with marked left axis cleviation is a type of bilatcral oundle branch block. thc charac- 1icristic electrocardiagraphic chj4iige which was describcd in 1934 by Wilson et al(I). Clinical, pathological, electrocarcliographic and vectorcardiographic studie.s on paticnts and experimpntal animals in recenL ycarsa-v proved that both bundle branclies WL?YC diseased, but the right louncile branch was more seriously diamaged tilian llie kft. main- iy the anterosuperior fascicle. This clisease is chiefly caused by +:xtcnsive mvoli'orosis or myocardial infarciion of the LmtOroSu- perior portion oF the ventricular septum<:). Daruage of the bLuxlle branchc-is dUring con- genital heart disease surgiory may tilso be a cause(3). lOTo of thc patic:niis rWWlop com- plcte heart block and/or Adams-Stokes syndrome(2,4). The following is a rcporrt on the ECGs of 13,770 cascs scen during 1954- 1975. The axis Was moasured bv the Zao Method(5)     

Three years'' experience with implanted pacemakers

At the University Hospital, Saskatoon, over the last three years, pacemakers have been inserted in 40 patients with complete or incomplete heart block. Fourteen of the patients were females and 26 were males. The average age was 65 years; 12 were over 80 years of age, and the youngest patient was 8 years of age. In none was the heart block due to operation. Thirty-three patients are still alive and well. There have been seven deaths three early and four late. One patient died because of a “runaway” pacemaker, and two as a result of infection persisting around the pacemaker. Twenty-nine Medtronic pacemakers were used and 14 Atricor pacemakers; currently we favour the latter instrument.