老年人永久起搏器置入术并发症的发生原因及处理策略

目的探讨老年人永久起搏器置入术并发症的发生原因及处理策略。方法393例老年患者，男251例，女142例，年龄60～94（77．5±5．3）岁。病态窦房结综合征237例，高度房室传导阻滞144例，双束支阻滞12例。置入单腔起搏器255例；双腔起搏器135例；三腔起搏器1例；置入性心脏除颤器2例。结果各种并发症共29例，发生率7．4％。导线电极移位14例（3．56％），囊袋血肿6例（1．53％）、囊袋感染3例（0．76％），废弃电极脱入右室、起搏器综合征各2例（0．51％），电极导线不全断裂、心肌穿孔各1例（0．25％）。结论做好充分的术前准备工作．术中熟练的无菌操作技术以及术后的密切观察和随访，可减少老年人永久起博器置入术并发症的发生；及时有效地处理并发症．可避免严重后果。

Causes of complications of permanent pacemaker implantation in elderly patients and strategies of management

Objective To explore the causes of complications of permanent pacemaker implantation in elderly patients and strategies of management. Methods A total of 393 elderly patients, including 251 males and 142 females, aged （77.5±5.3） years （ranged from 60 to 94）, were enrolled. Of them, 237 had sick sinus syndrome, 144 bad advanced atrioventricular block, and 12 had double bundle branch block： 255 of the patients had received single chamber pacemaker implantation, 135 dual chamber pacemaker implantation, 1 tri-chamber pacemaker implantation and 2 implanted cardiac defibrillator （ICD）. Results There were 29 complications altogether（7.4 %）, including 14 lead dislocation（3.56 % ） , 6 pocket haematomas（ 1.53% ）, 3 infection of pocket（0. 76%）, 2 abandoned leads falling into the right ventricle （0.51%） ： 2 pacemaker syndrome （0.51%） , 1 part fracture of lead electrode （0.25%） and 1 myocardial perforation （0.25 %）. Conclusion The key points to reduce the incidence of complications pacemaker implantation are careful preparation before operation, skillful aseptic technique and close observation and follow-up after operation. Early effective management of the complications can prevent them from becoming more serious.