学龄前儿童植入永久心脏起搏器的研究

目的研究学龄前儿童经静脉心内膜植入永久心脏起搏器的手术方法、安全性、疗效及并发症。方法回顾分析1994～2006年该院经静脉心内膜植入永久心脏起搏器的患者857例,其中4～6岁学龄前儿童3例,占0.35%。该组中男性2例,女性1例,年龄平均5岁,体重平均17.8公斤;1例为病毒性心肌炎并发窦性停搏,2例为室缺术后并发III度房室传导阻滞(atrioventricular block,AVB),均为经药物治疗无效的缓慢心律失常。3例均采用经静脉心内膜植入永久心脏起搏器的方法治疗,1例起搏电极经左锁骨下静脉,起搏器置于皮下与胸大肌之间;另2例电极经左头静脉,起搏器置于胸小肌与胸大肌之间。术后1周、1、3、6、9个月、1年及每年随访。结果3例患者均成功植入永久心脏起搏器。1例电极经左锁骨下静脉,起搏器置于皮下与胸大肌之间的患者于术后8个月出现起搏器囊袋磨破,继发感染,予取出起搏器,清创缝合,患者交界性逸搏心率55次/min,家属拒绝再次植入永久心脏起搏器,自动出院;另2例电极经左头静脉,起搏器置于胸小肌与胸大肌之间的患者,术后随访正常,无并发症。结论学龄前儿童缓慢型心律失常患者经静脉心内膜植入永久心脏起搏器是可行、有效的,但有出现起搏器囊袋磨破等并发症的风险;电极经头静脉,起搏器置于胸小肌与胸大肌之间相对安全。

Clinical analysis of preschool children after implantationg of artificial cardiac pacemakers

Objective] To analyze the method, safety, efficiency and complication of preschool children after implantationg of artificial cardiac pacemakers. Methods] Retrospective analysis of 857 patients after implantationg of artificial cardiac pacemakers in our hospital from 1994 to 2006 was carried out, and there were 3 preschool children among them(0.35%), 2 male and 1 femal, aged from 4 to 6(average 5)years old, average body weight 17.8 kilogram. One case was sinus arrest after viral myocarditis, the other two cases were third degree atrial ventricular block after operation of ventricular septal defect. All 3 cases planted artificial cardiac pacemakers transvenous. 1 pacemaker was planted between subcutaneous tissue and ectopectoralis with electrode cable in left subclavian vein, 2 pacemakers were planted between entopectoralis and ectopectoralis with electrode cable in left cephalic vein. Follow up after 1 week, 1, 3, 6, 9 month and every year. Results] Among all 3 cases planted artificial cardiac pacemakers successfully, one case whose pacemaker was planted between subcutaneous tissue and ectopectoralis complicated with rupture of pacemakers sac, and other 2 cases whose pacemakers were planted between entopectoralis and ectopectoralis were normal with no complications. Conclussion] Implantation of artificial cardiac pacemakers in preschool children with severe brady arhythmia is feasible and effective, but there may be complications such as rupture of pacemakers. The method that pacemaker is planted between entopectoralis and ectopectoralis with electrode cable in cephalic vein is safe relatively.