摘要
目的回顾性分析婴幼儿起搏器安装方法、特点及随访时相关并发症的处理。方法选择2000年4月至2011年12月行起搏器安装的婴幼儿，根据病因、年龄、体质量等情况，分别选择心内膜和心外膜起搏，病态窦房结综合征患儿行心房或心室起搏；先天性完全性房室传导阻滞患儿行心内膜起搏，起搏导线置入路径经颈内静脉或锁骨下静脉，外科手术后房室传导阻滞均行心外膜起搏；起搏器安装后予抗生素治疗5d后出院。随访时行心电图、胸片、心脏超声检查，并予起搏器程控。结果共46例，男29例，女17例；平均年龄（1．57±0．89）岁；平均体质量（10．93±3．34）kg；心内膜起搏17例，心外膜起搏29例；单腔起搏45例，双腔起搏1例；合并ASD2例，合并PDA2例，均先行介入治疗，然后安装起搏器；36例参与随访，平均随访时间为4．86年，13例因电池耗竭更换起搏器，7例因导线移位或脱落更换导线；1例完全性大动脉转位／室间隔缺损病例术后21d恢复房室传导拔除导线，2例分别在术后1个月和3个月时出现伤口感染、裂开，1例随访8年出现心功能不全，3例心外膜起搏病例后更换为心内双腔起搏，3例心内膜起搏由单腔起搏变为双腔起搏。结论婴幼儿行起搏器安装安全、有效、并发症少，需根据患儿具体情况选择心内膜或心外膜起搏，随访注意感染、导线移位、脱落和起搏电池过早耗竭等并发症。
Objective Retrospective analysis of pacemaker implantationsites and the follow-up results of its complications and treatment in infants. Methods Infants who implanted pacemakers between Apr. 2000 and Dev. 2011 were included in this study. Endocardial or epicardial pacing was selected based on the patients＇ condition, age and weight,infants with pathologic sinus syndrome were implanted AAI or VVI pacing model, endocardial pacing was used in patient with congenital complete atrioventricular block, the lead was advanced into right ventricle through subclavian or internal jugular vein, infants with 11I-AVB were often advised to implant epicardial pacing model postoperatively. An- tibiotics were used for about 5 days after operation, and then babies were discharged without any complication. In such patients, electrocardiogram, X-ray and echocardiogram examination, and programmed control of pacemaker should be no- ticed and follow-up study should be conducted. Re.suits Permanent pacemakers were implanted into 46 infants, 29 boys and 17 girls, the average age was （ 1.57 _＋ 0.89 ） years, the average weight was （ 10.93 ＋ 3.34 ） kg, 17 cases with endocardial pacing model and 29 cases with epicardial pacing,45 cases with single chamber pacing and only 1 case with dual chamber pacing,2 infants were combined with ASD and 2 with PDA, all of them were closed the defects firstly and then implanted pacemaker. Thirty-six patients were included in the follow-up study, the average follow-up time 4.86 years. New pacemakers were implanted because of battery exhaustion in 13 infants and 7 leads were changed because of lead shifting; the lead was extracted from a baby with D-trans position of great arteries（ D-TGA）/VSD after the recovery from atrioventricular conduction 21 days postoperatively. Superficial wound infections, and then wound dehiscence, presented in two babies after one or three months postoperatively; heart failure was found in one patient by 8-year-fol- low-ups ; endocardial pacing with DDD model replaced epicardial pacing in 3 patients ; and pacing model VVI was re- placed by pacing DDD in 3 cases. Conclusions The implantation of pacemaker in infant was safe, effective, with rare complications, the implantation of endocardial or epicardial pacing depends on infants＇ condition, and wound infection or unstable pacing caused by lead shifting or battery exhaustion should be closely watched.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第24期1878-1880,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
婴幼儿
永久性起搏器
随访
并发症
Infants
Permanent pacemaker
Follow-up
Complication
