起搏电极导线脱位的临床探讨

报道 6例起搏器电极导线脱位 ,1例为VDD起搏器 ,其余 5例均为DDD起搏器。共 8根电极导线脱位 ,7根为电极导线游动、1根呈微脱位。脱位后 ,2例再次发生晕厥、3例有明显症状 ,脱位电极导线均为双极电极导线。与以往电极导线脱位率相比 ,双极电极导线在临床中应用增多后引起的起搏电极脱位率有所增高 ,约占同期起搏器总数量的 2 %。这一现象应给予充分重视 ,并采取相应措施减少和预防其发生     

心脏起搏器电极脱位原因的初步探讨

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。     

左室电极导线的随访观察

行心脏再同步治疗(CRT)101例,随访29.5±19.5个月。左室电极导线脱位4例(占4.0%),其中2例轻度脱位,提高起搏阈值可起搏左室;1例脱至冠状窦,另1例为3根电极导线均脱到右房,此2例均重新置入。左室电极导线起搏阈值术后随时间延长呈逐渐增高的趋势,阻抗的变化趋势是逐渐降低。     

永久起搏器主动固定电极导线的长期随访观察

目的观察主动固定电极导线的长期参数变化,并探讨其应用的稳定性。方法2006年1月至2007年8月在沈阳军区总医院植入永久起搏器并置放主动固定电极导线的患者124例（共心房电极1根,心室电极124根）,其中男67例,平均年龄为（69±9）岁。植入部位：右心耳1例,室间隔93例,心尖部31例。测试手术后即刻及术后1、3、6、12个月的参数变化。结果参数变化：起搏阈值：手术即刻增高,术后1个月下降,两者有显著的统计学差异,术后3、6、12个月起搏阈值与术后1个月比较无明显改变。感知：手术即刻与术后多次随访均无明显变化。阻抗：手术即刻增高,术后随访各个月的阻抗均较手术即刻的阻抗低,与术中比较有显著统计学差异。2例患者在术后6个月时阈值升高。结论主动固定电极导线固定较牢固,脱位率低于被动固定电极导线,术后阈值升高发生率较低（1.6%）,长期观察参数均较稳定。     

双极起搏电极脱位的控制

起搏电极脱位曾是人工心脏起搏器置入技术最常见的并发症 ,近年来 ,多种原因使双极电极的临床应用有增多的趋势 ,但我们发现双极电极脱位率较高 ,为有效地减少脱位率 ,笔者结合本院发生的 5例探讨如何控制双极电极脱位的情况。1　对象与方法1 .1 　 对象我院 1 999年 1 1月～ 2 0 0 2年 1 1月 ,配用双极电极置入起搏器的 42例患者中 ,发生电极脱位者 5例 ,发生率为 1 1 .9% ,其中男 4例 ,女 1例 ,年龄 47～ 69( 5 7.4± 1 1 .3)岁 ;基础心脏病 :冠心病、病窦综合征 3例 ,心肌病、Ⅲ度房室阻滞 2例。1 .2 　 方法5例均置入Medtronic公司生产…     

起搏电极导线脱位

起搏电极导线脱位是起搏器术后常见的并发症。大多为发生在起搏器术后6周内的早期脱位,心房电极和双室同步起搏的冠状窦电极的脱位率较高。诊断电极脱位最简便、有效的检查是心电图和X线片,对疑诊患者,应进行起搏器程控。典型的电极导线脱位表现为起搏阈值升高和/或电极导线阻抗降低,严重脱位尚可引起感知不良。根据起搏器置入的时间、患者临床表现、脱位的电极导线情况以及起搏器功能障碍的程度不同,处理方法亦不同,而积极预防是最好的防治电极导线脱位的方法。     

植入式电极导线和临时起搏电极导线行临时心脏起搏的比较

目的比较植入式电极导线和临时起搏电极导线行临时心脏起搏(TCP)的效果。方法选择在本院行TCP的患者33例分为研究组(n=19)和对照组(n=14)。研究组采用植入式电极导线外接永久起搏器行TCP;对照组采用传统临时起搏电极导线行TCP。比较两种导线行TCP的阈值、脱位率及总费用。结果研究组10例使用主动电极导线,9例使用翼状被动电极导线,未发生脱位,对照组使用电极导线为(BARD0071539,6F型),脱位4例,均经重新定位。两组TCP 24h后的起搏阈值无明显差异(P>0.05)。研究组TCP术后住CCU病房的时间少于对照组[(0.6±0.4)d vs(3.2±1.3)d](P<0.05),总费用少于对照组[(4 587±398)元vs(7 636±567)元](P<0.05)。结论应用植入式电极导线比临时起搏电极导线行TCP更安全、实用、经济。     

经下腔静脉途径反推力牵引法拔除永久性起搏电极导线

采用经下腔静脉途径 ,对 11例起搏器术后顽固性感染和 2例电极导线断裂患者的电极导线进行血管内反推力牵引拔除术。需拔除电极导线共 17根 (心房和心室电极导线分别为 5和 12根 ) ,其中 15根因起搏器囊袋感染和破溃需拔除的电极导线置入时间为 11.5± 3.5 (8～ 2 0 )年 ,经上腔静脉途径拔除失败。结果 :经下腔静脉途径完全拔除电极导线 15根、不完全拔除 1根、失败 1根 ,无严重并发症。表明对置入年限长久和断裂电极导线 ,经下腔静脉途径的拔除成功率高 ,应作为首选拔除途径     

心脏起搏主动与被动电极导线的拔除难度对比研究

目的 探究心脏起搏主动与被动电极导线在拔除的手术时间和并发症上是否存在差异。方法 选取新疆医科大学第一附属医院从2016年1月至2022年6月进行电极导线拔除的病人共109例，去除除颤电极导线患者8例，未使用工具拔除患者54例，剩余47例，共77根电极导线，其中主动电极导线31根，被动电极导线46根，其中22根使用锚定钢丝拔除，55根使用针眼圈套器拔除。比较两种电极导线之间的手术时间和并发症情况。结果 两组患者的年龄、性别、基础疾病、拔除原因无明显差异。在未进行电极导线使用年限匹配的情况下，主动电极导线的拔除时间明显减少[(46.74±17.95)min vs(56.41±19.61)min,P=0.031],心房主动电极导线的拔除时间较被动电极导线明显缩短[(30.42±10.84)min vs(52.90±19.82)min,P=0.009],在心室电极导线中，两种电极导线的拔除时间无明显差异[(51.50±16.89)min vs(59.36±19.34)min,P=0.137]。主动电极导线的使用年限较短[(4.60±3.64)年vs(10.27±4.26)年，P<0.0...     

应用激光鞘拔除电极导线(附五例报道)

目的探讨应用激光鞘拔除电极导线的安全性、可行性。方法回顾分析北京大学人民医院应用激光鞘拔除电极导线的5例患者资料,总结电极导线拔除原因、电极导线特点、手术相关并发症、手术时间、曝光时间、曝光量等。结果 5例患者(2例女性),年龄(62.8±16)岁,其中1例为Ⅱa类适应证,4例为I类适应证,共拔除电极导线8根(2根除颤电极导线),均成功拔除,无并发症发生,手术时间、曝光时间、曝光量的中位数分别为4 min、1min 35 s、1.305 mgy。结论对于大的、有经验的中心,应用激光鞘拔除电极导线是安全、可行的。     

双房起搏对房性快速性心律失常的治疗

目的 :评价双房起搏治疗伴房间传导阻滞 (IACB)患者的阵发性房性快速性心律失常的疗效和安全性。方法 :15例患者均行左锁骨下静脉穿刺 ,X线采用正位和左前斜位 ,依次置入冠状窦、右室、右房电极 ,测试起搏参数满意后 ,经Y型转接器将冠状窦电极和右房电极组成新的双极电极 ,置入后分别行AAT、DDD或DDTA起搏。结果 :1例术中冠状窦电极脱位而放弃双房起搏 ,2例术后冠状窦电极脱位 ,均成功复位 ,2例由于程控不当造成起搏器介导性心动过速 ,其余病例未出现并发症。随访 2～ 32个月 ,9例显效 (6 4 .3% ) ,2例有效 ,3例无效。结论 :双房起搏能有效防治并发高度房间传导阻滞患者的阵发性心房扑动、心房颤动。普通心室电极经冠状窦行永久左房起搏安全、有效、脱位率低 ,值得推广和应用     

Necessity of radiographs in the emergency department management of shoulder dislocations

STUDY OBJECTIVE: To determine the necessity of radiographs in the emergency department management of patients with suspected shoulder dislocation. METHODS: A prospective, observational study was conducted at a university-affiliated, Level I trauma center ED with an emergency medicine residency program. Physicians entered all patients with a suspected shoulder dislocation and reported whether they were certain that the patient's shoulder was dislocated or reduced, before obtaining radiographs. Outcome measures were the assessments of joint position and the radiology reports of prereduction and postreduction films. RESULTS: One hundred four patients were enrolled in the study, including 98 with shoulder dislocations, and 191 physician assessments were performed (96 prereduction, 95 postreduction). Twenty-eight patients had recurrent dislocations with an atraumatic mechanism (group 1), and 76 had no prior dislocation or a blunt mechanism of injury (group 2). There were no fractures in group 1 patients; the accuracy of confident assessments was 100% (95% confidence interval 92% to 100%). In group 2, the accuracy of confident assessments was 98% (95% confidence interval 94% to 100%). Incorrect assessments occurred only in patients with fractures. A derived algorithm would have reduced radiographs by 51%. CONCLUSION: Physicians are highly accurate in the clinical determination of shoulder dislocation and relocation. Radiographs should be obtained when the physician is uncertain of dislocation or reduction. Prereduction films should be obtained for patients with a blunt traumatic mechanism of injury, and postreduction for those found to have a fracture-dislocation. However, postreduction films add little in patients without fractures, and neither prereduction nor postreduction films are likely to affect the ED management of patients with recurrent dislocation by an atraumatic mechanism. Prospective validation of the derived algorithm is suggested.     

器械升级时原起搏导线及囊袋的处理

目的观察器械升级时原起搏导线及囊袋处理的方法、可行性和安全性。方法本组共11例患者,根据升级后所应用器械分为心脏再同步治疗（CRT）组及植入型心脏再同步治疗除颤器（CRT—D）组。CRT组5例患者,其中4例升级前为单腔起搏器（VVI）,1例为双腔起搏器（DDD）;CRT—D组6例,升级前分别为1例VVI、2例DDD、2例单腔植入型心律转复除颤器（ICD）及1例CRT。起搏器囊袋依患者情况而定,但CRT—D囊袋须往左侧胸部。结果常规起搏器升级为CRT者,除1例原双极心室导线各参数均符合更换时要求外,弃用其他单极心房、心室导线,重新植入新的双极导线。升级为CRT—D者,1例VVI起搏器,弃用原单极心室导线,植入ICD心室导线,同时植入双极心房起搏导线和左心室导线;2例双腔起搏器原心房导线均为单极,予弃用,重新植入双极心房导线,心室新植入ICD导线;2例原ICD导线均能续用;1例CRT升级仪需新债入ICD导线。起搏器衰袋除1例存右侧胸部外,余10例均在左侧胸部。结论器械的升级是安仝、可行的,对原起搏导线需评估后依不同情况分别作出相应的处理。     

Evaluation of 3 chest leads CM5, CC5, and CL5 and factors which influence the results

In recent few years, many authors had discussed the possibilities of using bipolar precordial leads to replace lead V5 in diagnosing anterior wall myocardial ischemia. But there still remains some problems to be solved: (1) Are there any difference between bipolar precordial leads and lead V5 in wave forms? (2) What kind of factors influence the ST deviation? 36 patients were studied by comparing unipolar lead V5 with respect to three different bipolar chest leads CM5, CC5, CL5 both in lying and sitting positions. We found that: (1) The differences is least significant between bipolar CC5 and lead V5 while it is most significant between bipolar lead CM5 and lead V5. (2) The deviation of ST segment in bipolar leads is affected both by potential at negative electrode as well as potential at positive electrode. Statistical analysis revealed that ST segment is positively related to the potential on positive electrode and negatively related to the potential on negative electrode. For this reason, therefore, in the view point of most comparable ST deviation with lead V5 for monitoring of myocardial ischemia, it is advisable to locate the negative electrode at the site on chest with least potential. Usually we place the negative electrode on V6R to compose a bipolar lead CC5.     

80岁及以上患者髋关节置换术围手术期并发症预防和对策

目的 探讨老年高危患者关节置换术围手术期并发症的预防和处理对策.方法 80～94岁髋关节置换术患者42例,并存重度骨质疏松(Dorr Ⅲ期)24例,采用骨水泥柄双极股骨头置换术25例,非骨水泥柄双极股骨头置换术2例,7例骨水泥全髋关节置换术,3例全髋关节翻修术.结果术中无死亡,1例90岁女性患者术后第5天关节脱位,复位后次日死亡,1例全麻术后昏迷1周后苏醒,5例术后3 d内发生认知障碍.38例(90.5%)出院时可扶助行器行走,患髋关节疼痛缓解.结论 对于需要行髋关节置换术的老年患者,进行关节置换术必须经过围手术期多学科的紧密配合协作,采用对应的手术和治疗对策,这样可以降低手术并发症的发生率或减轻并发症的程度,保证手术的成功.     

双动人工股骨头置换治疗老年股骨颈骨折

目的股骨颈骨折是老年人常见病，治疗效果不确实，并发症多，我们采用双动人工股骨头置换治疗老年股骨颈骨折，观察其疗效。方法我们在１９８９～１９９４年对６７例老年股骨颈骨折患者采用了６１２所生产的双动人工股骨头。对其中７０岁以上和陈旧性骨折患者３４例，因骨质疏松明显，使用骨水泥固定假体柄，其余患者使用珍珠面的假体柄，并进行了１～６年随访。结果根据Ｈａｒｒｉｓ评分，术后平均９２分，治疗效果优良率为９３％，６２例患者能早期活动，尽快恢复生活自理，无１例感染及下肢静脉栓塞。１例关节脱位，１例骨化性肌炎。另３例为疼痛，其中２例发生松动，假体下沉，１例为假体选择不当。结论双动人工股骨头置换术具有手术方法安全、简单、并发症少，术后关节功能恢复快等特点，是治疗老年股骨颈骨折的有效方法。     

Post-mortem evaluation of 415 pacemakers: in situ measurements and bench tests.

AIM: The hypothesis was that there is more undetected dysfunction of implanted pacemaker systems than that detected and corrected. This prompted a research project (sponsored by the German Research Foundation) to detect pacemaker abnormalities and evaluate their complications for patients, thus, proving or disproving the hypothesis. METHODS AND RESULTS: Four hundred and fifteen pacemakers of deceased patients were analyzed assessing their functionality by in situ measurements and bench tests including five measurements and one telemetric interrogation. Results were divided into four categories and statistically evaluated. Life-threatening abnormalities were found in 3.8%, potentially life-threatening in 3.7%, probably symptomatic, divided into atrial and ventricular problems, 13.3% and 2.8%, respectively, and premature exhaustion in 1.2%. Three of 179 bipolar ventricular leads and 2 of 131 bipolar atrial leads had insulation defects corresponding to 1.7% and 1.5%, respectively. The bipolar complication rate was 2.8 times higher than unipolar. CONCLUSION: The pacemaker patients investigated, living 4 years with their pacemaker on average, had a post-mortem evaluated complication rate of the category "life-threatening" of 3.8%. This result corresponds to an annual complication rate of 0.94% compared with a rate of only 0.39% in an earlier investigation.     

Bilateral traumatic testicular dislocation--a case report

Traumatic testicular dislocation is a rare complication of blunt scrotal trauma. It is usually related to straddle injuries from motorcycle accidents and is commonly accompanied by scrotal hematoma and pelvic fracture. Bilateral dislocation of the testes is relatively rare. We report a rare case of bilateral testicular dislocation after a motorcycle accident. Abdominal computed tomography (CT) and color Doppler ultrasonography are helpful in locating the dislocated testicle and detecting its blood flow. Closed reduction of a superficial testicular dislocation may be attempted first. After appropriate physical examination and image study, emergent surgical reduction should be considered because of the high incidence of failure of closed reduction. We recommend that emergency physicians should be aware of potential testicular injury among trauma cases. Early reduction and early urological consultation are also recommended because of histological changes seen in dislocated testis.