462例永久起搏器置入术并发症的相关因素分析及防治对策

分析 4 6 2例永久起搏器置入术发生的并发症原因 ,以利减少其发生率。选择 1995年 3月～ 2 0 0 3年 12月因缓慢或快速心律失常置入起搏器或自动复律器 (ICD)的患者 4 6 2例。其中男 2 2 4例 ,女 2 38例 ;缓慢性心律失常4 4 8例、快速性心律失常 (室性心动过速或心室颤动 ) 14例 ;4 6 2例起搏器中单腔起搏器 2 4 1例、双腔起搏器 2 0 7例(包括部分双室起搏 )、三腔起搏器及ICD 14例。术后常见的并发症分别是囊袋内积血及血肿 (6 .1% )、电极导线脱位 (1.5 % )、囊袋破溃及感染 (1.1% ) ,积血的发生与年龄偏大和术后使用阿司匹林有关 ,电极导线的脱位主要是固定的、结扎线松开 ,电极导线固定不良所致 ;感染的发生主要在慢性期 ,尤其是更换起搏器的患者 ,考虑囊袋制作偏小、或与原起搏器形状不相称引起皮肤受压缺血 ,激发无菌性炎症 ,破溃后发生细菌性感染是其主要原因。结论 :采取相应措施 ,可以减少此类并发症。

Analysis of the Causes of Complication and Appropriate Measures in 462 Patients With Pacemarker Implantation

The complications in 462 patients with pacemakers implantation were analyzed in order to find causes and to avoid this situation. 462 patients (448 patients with bradycardia, 14 with tachycardia) were implanted pacemaker or ICD. Of these patients, 224 were male, the others were female, 241 with single chamber pacemaker, 207 with dual chamber pacemakers, 14 with tri chamber pacemakers or ICD. The common complications related to operation were blood effusion and hematoma formation in pocket (6.1%), lead dislodgement (1.5%) and infection with or without pocket rapture (1.1%). Occurrence of blood effusion was related to old age and aspirin administration. Dislodgement of the pacing leads was related the uncompleted ligation due to the slide ligature made by the operator. All pocket infection that was especially seen in the patients with pacemaker replacement were happened in the late period, the reasons were considered as that original pocket′s shape or size does not fit well with later pacemaker, which caused the skin ischemia, and lead to the pocket skin rapture and infection. Conclusion:Appropriate measures could be taken to avoid these complications.