80岁以上老年人心脏起搏器植入术及减少并发症的对策

目的 探讨80岁以上老年人起搏器植入手术方式的选择,旨在减少相关并发症及提高生活质量.方法 80岁以上老年人127例植入起搏器.其中双腔起搏（包括双室三腔起搏）95例（74.8%）;单腔心室起搏32例（25.2%）.所有患者首选经头静脉放置起搏电极导线,并对寻找头静脉及电极导线植入方式做了较大的改进.电极导线的头端应固定在心腔内,切口内起搏器囊袋处的固定也十分重要.在电极导线送入心内前制作起搏器囊袋,并放置纱布压迫止血,对少数渗血较多的患者,局部适当加凝血酶或用电凝刀止血.鼓励患者术后早期下床（手术当日或次日）.结果 经头静脉送入起搏导线的成功率,在单腔起搏器为92.0%,双腔起搏器81.5%.术中及术后早期发生并发症5例（3.9%）,分别是：囊袋血肿3例（2.4%）,电极导线与起搏器连接处松动1例（0.8%）,心肌穿孔1例（0.8%）.无血气胸、电极导线脱位及起搏器囊袋感染发生.结论 经头静脉送入起搏电极导线可避免锁骨下穿刺所导致的并发症,在老年人中尤其重要;电极导线脱位主要与手术操作有关,而与早期下床活动无关;应采用适当方法达到囊袋内彻底止血,减少术后囊袋血肿及感染.

Pacemaker implantation and complication reduction strategy in elderly patients over 80 years old.

Objective To investigate the way of pacemaker implantation in 127 elderly patients over 80 years old to reduce postoperative complications and improve the life quality. Methods One hundred and twenty-seven patients over 80 years old had the dual chamber pacing in 95 cases(74. 8%, including tri-chamber pacing) and the single ventricular pacing in 32 cases (25. 2%). Cephalic veins were used primarily in all patients with modified methods. The safe fixation of pacing leads were emphasized not only in the heart but also in the site of pacemaker pocket. The pacemaker package was made prior to the leads insertion in order to have enough time for stopping bleeding. It was necessary for some cases with diffused bleeding to use electric coagulation. All patients were told to get out of bed in the operating day or the day after procedure. Results Cephalic vein was well exposed. The successful rates of implanting pacing leads directly through cephalic vein were 92. 0% and 81. 5% in the single chamber and dual chamber patients, respectively. The overall complications observed in 5 cases(3. 9%) were pocket hematoma formation in 3 cases (2. 4%), cardiac tamponade in 1 case (0.8%), and disconnection of pacemaker with lead in 1 case (0.8%). There were no hemothorax, infection and lead dislodgement. Conclusions Insertion of pacing lead through cephalic vein is important, especially for the advanced aged patients. This operation can decrease the complications of subclavian vein puncture. Leads dislodgement are mainly due to the inadequate skill of operator, not to the patient s early activity out of bed. Appropriate way for stopping bleeding is the key to protect the patients from pacemaker pocket effusion and hemotama.