292例永久心脏起搏器置入术患者的长期随访分析

目的 分析永久性人工心脏起搏器置入术后患者长期随访的的临床结果.方法 回顾性分析我院292例置入永久性起搏器后患者术后随访及程控资料,随访时间1～10年,随访内容包括患者的临床症状、心功能情况、生存率、起搏器故障发生情况,行多导联心电图、胸部X线及超声心动图检查,根据需要对部分患者行起搏方式及起搏参数调整.结果 292例患者中,术前主诉的心动过缓相关症状,包括头昏、黑矇、胸闷、心悸、气短等症状均消失或减轻;患者的心功能有所改善,平均LVEF值由术前的0.43±0.07提高到术后的0.57±0.06（P＜0.05）,运动耐量提高,生活质量改善.随访期间,12例患者死亡,其中4例患者因脑血管意外死亡,5例患者因心功能衰竭死亡,3例患者因恶性肿瘤死亡.共发现各种并发症39例,包括起搏器囊袋破溃、起搏电极脱位、起搏或感知不良、心律失常、膈肌刺激、起搏器综合征等,均及时以不同的方法处理.结论 基层医院对置入永久人工心脏起搏器后的患者进行定期随访非常重要,可及时发现和处理与起搏器相关的并发症及排除起搏故障.

The analysis of long term follow-up of 292 cases with cardiac pacemaker implantation

Objective To analysis the clinical results in patients with long term follow-up after permanent cardiac pacemaker implantation. Methods Retrospective analysis was based on 292 cases with permanent pacemaker implantation, and postoperative clinical data and conventional 1-10 year follow-up data. Clinical symptoms, survival rate, post-operative complications and the occurrence of pacing dysfunction were record. Results In 292 patients, all symptoms relate to bradycardia be relieved. There was significant statistically improve in heart function during the whole observation period LVEF： （0.43±0.07） vs （0.57±0.06）, P〈0.05 ]. A total of 12 patients died during the whole follow-up period. 4 patients died of cerebrovascular disease. 5 patients died of heart failure. 3 patients died of cancer. 39 cases of pacemaker complications occurred including capsular hematoma and capsular rupture, pacing electrode catheter dislocation, perceptual dysfunction, and pacemaker-mediated tachycardia （PMT）, and pacemaker syndrome. All cases adopted to adjust the pacing parameter, and then normal pacemaker function recovered. Conclusion It＇s very important to strengthen the job of long-term postoperative follow-up in patients with pacemaker implantation. Detection of certain pacing dysfunction and pacemaker-related complications, to explore the reasons and deal with it timely and accordingly.