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1、#480#中国心脏起搏与心电生理杂志2009年第23卷第6期#临床研究#110例心脏再同步化治疗中左室电极导线植入的临床经验和并发症分析臧红云王冬梅韩雅玲于海波邓捷[摘要]目的探讨心脏再同步化治疗(CRT)中左室电极的植入方法、特殊病情的个体化处理及并发症的预防。方法对110例心力衰竭患者行CRT。左室电极植入的方法:冠状静脉窦(CS)插管、CS及心脏静脉逆行造影(RCV)、选择靶静脉并植入电极。根据RCV静脉解剖特点选择靶静脉及特殊情况个体化处理。观察左室电极植入的成功率、左室电极的型号、置入CS靶静脉的部位、并发症。结果左室电极植入成功率为96.4%(106/
2、110),4例左室电极未成功植入者包括1例植入DDD双腔起搏器、2例植入埋藏式心脏转复除颤器(ICD)及1例行心外膜左室电极植入术。9例特殊情况需个体化处理,其中2例心侧静脉狭窄应用球囊扩张数次,3例应用多根经皮球囊扩张冠状动脉成形术(PTCA)导丝加强支撑下植入左室电极,4例需更换不同型号或厂家的电极(包括3例术中和1例择期更换)。术中发生冠状静脉夹层或心肌穿孔5例(4.7%),仅1例择期CRT成功,另4例发生轻微夹层,少量或未见心包积液,但血流动力学稳定未影响左室电极置入。术中急性左室心力衰竭4例(3.7%),室性心动过速、心室颤动2例(1.9%),均经治疗未
3、影响手术。结论左室电极植入有一定的风险和难度,采取个体化处理策略,可提高左室电极植入的成功率、并使并发症降至最低限度。[关键词]心血管病学;左室电极;心脏再同步化治疗;并发症中图分类号R318.11文献标识码A文章编号1007-2659(2009)06-0480-04Theapplicationofleftventricularleadimplantationandanalysisofcomplicationsin110patientswithcardiacre-synchronizationtherapy.ZANGHong-yun,WANGDong-me,iHA
4、NYa-ling,YUHa-ibo,DENGJie.DeparmtentofCardiology,ShengyanCommandGeneralHospital,Shenyang110016,ChinaCorrespondingauthor:HANYa-ling[Abstract]ObjectiveToobservetheclinicalproblemsofleftventricularleadmiplantationduringoperationincardiacresynchronizationtherapy(CRT).MethodsOnehundredandt
5、enpatientsreceivedCRTwereincludedinthisstudy.Thesuccessrateofleftventricularlead,typesofleftventricularlead,thelocationofleftventricularleadinCSandcompl-icationsinthesepatientswereobserved.ResultsLeftventricularleadsweresuccessfullymiplantedin106cases(96.4%),notsuccessfullyimplantedin
6、4(DDDwasmiplantedin1,ICDin2andtheleftventricleepicardialleadin1pa-tient).Thepromptmanagementstotherelatedproblemsofleftventricularleadswereusedin9cases(veinballoondilationwasusedin2,multiplePTCAwireshelpedleftventricularleadmiplantationin3,differentleftventricularleadwaschangedin4duri
7、ngoperation).Dissectionandmyocardialperforationhappenedin5patients(theoperationwasdelayedin1caseandnotinfluencedin4cases).Acuteleftventricularheartfailureoccurredin4cases,ventriculartachycardiaandventricularfibrillationin2cases.ConclusionTherisksofleftventricularleadmiplantationrelate
8、withv
