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1、中国心血管病研究杂志2007年6月第5卷第6期ChineseJournalofCardiovascularReview,June2007,Vol.5,No.6·411·临床研究心脏起搏器电极脱位原因的初步探讨邹彤王志蕾佟佳宾李梅吴素娟杨杰孚作者单位:100730北京市,卫生部北京医院心内科电生理室【摘要】目的随访起搏器置入术后患者,观察起搏电极导线脱位的情况,分析和探讨电极导线脱位的原因。方法总结1065例置入起搏器患者的临床资料,24例起搏器电极导线脱位,7例为VVI/VVIR起搏器,其余15例为DDD/DDDR起搏器。结果共24根电
2、极导线脱位,其中15例电极导线明显移位,9例电极导线微脱位,11根为心室电极导线,13根为心房电极导线。脱位电极导线中23根为双极电极导线,1根为单极电极导线。脱位后3例发生晕厥,3例有黑矇症状。结论心房电极导线脱位率高于心室电极导线,大多数电极导线脱位发生于术后1周内。双极电极导线在临床应用增多后引起的起搏电极脱位率高于单极电极导线,老年人合并基础心脏疾病者电极导线脱位的危险性增高。此外,电极导线脱位与术者置入经验可能有关。【关键词】心脏起搏器,人工;脱位,电极Discussthecauseandofpacemakerleaddisl
3、ocationZOUTong,WANGZhi-lei,TONGJia-bin,etal.DepartmentofElectrophysiologyBeijingHospital,Beijing100730,China【Abstract】ObjectiveTofollowupthepatientswithpacemaker,observetheconditionofpacemakerleaddislocation,toexplorethecauseofleaddislocation.ResultsSummarizingtheclinica
4、ldataof1065patientswithpacemakers,7patientswithVVI/VVIRpacemakersand15patientswithDDD/DDDRpacemakers.MethodsWereport24pacemakerleadsdislocation,15leadswerevisibledislocated,9leadsweremildlydislo-cated,including11ventricularleads,13atrialeads.Duringthedislocationleads,23w
5、erebipolarleads,andonewasunipolarlead.Afterthedislocation,3patientshadsyncope,3patientshadthepre-syncope.ConclusionsTheratioofdislocationofatrialeadswashigherthanventricularleads,mostofthedislocationhappenedduringoneweekafterimplanting.Theratioofdislocationhasbeenincreas
6、edfollowingthewideuseofbipolarleadsinclinicalpractice,comparedwiththeunipolarleads.Theelderlypatientswithheartdiseasehadhighriskofleaddislocation.Inaddition,theoccurrenceofleaddislocationisassociatedwiththeexperienceofoperator.【Keywords】Pacemaker,artificial;Dislocation,e
7、lectrodes中图分类号R318.11文献标识码A文章编号1672-5301(2007)06-0411-03自心脏起搏器普遍应用于临床工作中以来,起中起搏电极导线脱位患者24例,男性14例,女性搏导线电极脱位是心脏起搏器置入术的重要并发10例,年龄59~85(72.3±9.6)岁,均为首次起搏器症,可引起严重后果,甚至可能危及患者的生命。置入。基础心血管疾病:高血压10例,冠心病5上世纪80年代前使用平直柱状头电极脱位率可达例,心肌病3例,风心病2例;Ⅲ度房室阻滞3例,10%~20%,严重制约了此项技术的推广和发展。但Ⅱ度Ⅱ型房室阻
8、滞3例,病窦综合征11例,永久性近年来随着起搏工程技术的改进,采用了楔状或房颤伴高度房室传导阻滞7例。翼状电极,脱位的发生率已明显降低[1]。但有报道,1.2起搏电极导线相关资料24例患者17例置近几年来起