永久起搏器植入术后压迫方法的改进

目的探讨降低永久起搏器植入术后并发症、提高患者舒适度的伤口护理方法。方法将200例永久起搏器植入术后患者随机分为对照组和观察组各100例。对照组采用传统沙袋压迫法进行伤口处理,观察组采用X型加压包扎方法进行伤口处理。结果两组均未发生电极脱位,观察组伤口出血、伤口疼痛及肩背疼痛发生率显著低于对照组(均P0.01)。结论永久起搏器植入术后采用X型加压包扎不影响电极位置,可降低伤口出血发生率,提高患者术后舒适度。     

老年患者永久起搏器植入术后早发型囊袋感染的处理

起搏器囊袋感染是永久起搏器植入术后较为常见的并发症之一,若不及早发现和处理,将导致囊袋破溃,迁延不愈,严重者可出现感染全身播散,甚至合并感染性心内膜炎.我院1989年10月-2006年10月共有122例患者行永久起搏器植入术,其中2例发生囊袋感染,经及时治疗后治愈,报告如下.     

起搏器安置术与冠状动脉造影同时进行的意义及临床安全性探讨

目的：探讨起博器安置术与冠状动脉造影（CAG）同时的临床意义及安全性。方法回顾性分析2012年3月至2013年12月97例植入起搏器患者资料,以是否同时进行CAG分为造影组41例和非造影组56例,观察冠心病在缓慢性心律失常患者中的比例,以及起搏器囊袋出血情况。结果造影组造影检出冠心病25例占59.5%,高于临床诊断的20例（漏诊7例,误诊2例）,占47.6%;造影组发生囊袋出血4例（9.5%）,非造影组发生5例（8.9%）,两组囊袋出血发生率差异无统计学意义（α2=87.46,P＆gt;0.05）。结论起博器安置术与冠状动脉造影同时进行是安全的,且可发现严重的冠脉病变,为下一步治疗提供依据,同时减少住院时间及住院费用,具有一定的临床意义。     

永久心脏起搏器植入术后并发症的护理干预

目的分析永久心脏起搏器植入术后并发症的护理措施。方法对33例心脏起搏器植入术患者的临床护理资料进行回归性分析,总结对其术后并发症的实施综合护理的方法。结果本组33例患者均顺利植入起搏器,术后发生并发症3例(9.01%)。其中囊袋出血2例,起搏器综合征1例,经综合护理后全部康复,无电极移位等其他并发症发生。出院时患者症状明显缓解,起搏器感知及起搏功能良好。结论对实施起搏器植入术患者重视术后并发症的预防,有针对性的实施综合护理措施,可降低术后并发症发生率,提高手术效果,改善术后患者生活质量。     

小组健康教育对起搏器植入术后患者生活质量的影响

目的探讨小组健康教育对植入永久性人工心脏起搏器患者生活质量的影响。方法将104例植入起搏器患者随机分为对照组和观察组各52例。对照组行常规随访，观察组在此基础上采取小组健康教育。结果观察组出院后3、6、12个月生活质量评分（除物质生活状态维度外）显著高于对照纽（均P〈0．05）。结论小组健康教育可发挥团队的力量，使健康教育更具有针对性，能明显改善起搏器植入术后患者的生活质量。     

小组健康教育对起搏器植入术后患者生活质量的影响

目的探讨小组健康教育对植入永久性人工心脏起搏器患者生活质量的影响。方法将104例植入起搏器患者随机分为对照组和观察组各52例。对照组行常规随访,观察组在此基础上采取小组健康教育。结果观察组出院后3、6、12个月生活质量评分(除物质生活状态维度外)显著高于对照组(均P0.05)。结论小组健康教育可发挥团队的力量,使健康教育更具有针对性,能明显改善起搏器植入术后患者的生活质量。     

心脏转复除颤器植入术患者的护理

目的总结植入型心脏转复除颤器(ICD)植入术的护理要点和常见并发症的处理方法。方法对收治的心源性猝死抢救成功的7例患者行ICD植入术,术前加强心电监护及病情观察;术后持续心电、血压监测,尤其注意观察心率、心律的变化,做好休息与饮食、疼痛及生命体征护理和健康教育,及时处理常见并发症和意外。结果 7例患者住院14~30 d,出院时的心功能NHYA分级Ⅱ~Ⅲ级。随访2~52个月,1例患者术后14个月因肺部感染、泵衰竭死亡。其余6例存活患者共记录到4次放电过程,3次室性心动过速和1次室上性心动过速,放电后均成功转复窦律;1例并发电击幻觉,1例囊袋渗液,经对症处理均好转。结论加强ICD植入术患者生命体征的观察,完善基础护理和心理护理,对可能发生的并发症采取针对性防护措施,能降低并发症及意外的发生,延长ICD的使用寿命。     

早期康复护理对人工心脏起搏器植入术后患者肩功能恢复的影响

用微型角膜刀行角膜深板层内皮移植术治疗大泡性角膜病变患者18例．效果满意。认为做好充分的术前准备,密切的术中配合．特别是对微型角膜刀使用的准确配合,是提高手术成功率、减少并发症的重要保证。     

加压包扎与负压引流对全髋关节置换术后失血量及血肿形成影响的比较

目的 比较负压引流和加压包扎对全髋置换术后出血量和血肿形成状况的影响.方法 选取105例因骨关节炎进行初次单侧全髋置换术的患者,随机分为负压引流组(54例)和加压包扎组(51例).负压引流组采用Redovac 400高真空引流系统;加压包扎组采用CDS加压包扎系统.采用血红蛋白平衡法计算术后失血量,以超声评估术后血肿最大厚度.结果 两组术前及术后5 d血红蛋白数值差异无显著性.总失血量加压包扎组少于负压引流组,术中出血量两组间差异无显著性,术后失血量加压包扎组少于负压引流组,术后输血量加压包扎组少于负压引流组,两组间血肿厚度差异无显著性.结论 在初次全髋置换术后,可以使用加压包扎来代替传统的负压引流.     

冠状动脉介入术后桡动脉压迫方法的改进

目的 探讨冠状动脉介入术后桡动脉不同压迫止血方法的临床效果.方法 将100例经桡动脉穿刺冠状动脉介入检查治疗的患者随机分成观察组和对照组各50例,对照组采用弹力绷带加压包扎法.观察组采用宽胶带压迫止血法,比较两组止血效果.结果 两组各有2例患者发生局部出血;观察组SpO<,2>值,患侧手指发绀、肿胀发生率显著低于对照组,而舒适度显著高于对照组(均P<0.01).结论 经桡动脉行冠状动脉介入术后采用宽胶带压迫穿刺处止血法效果好,并发症少,舒适度高.     

A modified self-retaining retractor for epimyocardial pacemaker implantation

A modified self-retaining retractor facilitating wide access to the ventricular surface for epimyocardial permanent pacemaker implantation through the subxiphoid approach is described.     

A new technique for permanent pacemaker implantation in infants and children

Permanent pacemaker implantation in the infant or young child presents the surgeon with many technical problems unique to this population. A new technique of implantation is described that was used successfully in 6 pediatric patients. The technique is simple to perform and gives very satisfactory results.     

Transvenous permanent pacemaker implantation for Fabry's disease. 3 cases report

Three men with Fabry's disease (angiokeratoma corporis diffusum universal ) are described. In the first patient, atrial fibrillation appeared, and a permanent cardiac pacemaker (VVI) was implanted. Sick sinus syndrome with complete atrioventricular block was occurred on the second patient. Transvenous pacemaker (DDD) implantation was performed for him. The last patient was younger brother of the second patient. He demonstrated complete atrio-ventricular block, so cardiac pace maker (VAT) was implanted. They showed a low value of granulocyte's alpha-galactosidase activity. During 1 to 4 year follow up period, they showed no trouble about pacemaking. Fabry's disease is an disorder of glycosphingolipid metabolism. This disorder is characterized by the accumulation of trihexosyl ceramide in many sites. Cardiac involvement and abnormal electrocardiographic manifestations are common in this disorder. Permanent cardiac pacemaker is necessary for severe bradycardia caused by this disorder.     

Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement

BACKGROUND: The aim of this study was to evaluate the frequency of requirement for permanent pacing and related risk factors after aortic valve replacement. METHODS: Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 +/- 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%. RESULTS: Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors. CONCLUSION: Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension.     

Emergent permanent pacemaker implantation in a premature 1,502 g neonate

We report a case of an emergent pacemaker implantation in a 1,502 g preterm neonate immediately after birth due to congenital complete atrioventricular block. At a gestational age of 29 weeks the patient was delivered by cesarean section followed by unsuccessful drug treatment of the atrioventricular block. Sixty-five minutes after birth the patient underwent permanent pacemaker implantation. Through a subxyphoid approach, a lead was fixed to the epicardium of the right ventricle, and connected to a pulse generator inserted between the rectus abdominus muscle and posterior rectus sheath. The patient is alive and well 16 months after the operation without pacemaker failure.     

人工起搏器置入352例常见并发症临床分析

目的：分析永久起搏器术后常见并发症的发生原因、处理方法及预防措施。方法：回顾分析解放军总医院第一附属医院1992年8月-2007年12月安装永久起搏器352例患者的临床资料和并发症。结果：男性134例,女性118例,单腔起搏器218例,双腔起搏器122例,三腔起搏器2例。术后常见并发症共17例次,其中感染3例,囊袋积血2例,脂肪液化1例,囊袋破溃2例,电极脱位及微脱位5例,术后心律失常1例,三尖瓣穿孔1例,局部肌肉跳动1例,急性期大面积脑梗塞1例。结论：重视术前预防、规范术中操作、加强术后随访,早期发现、积极处理各种并发症,最大的减少并发症的发生。     

Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults

Background

Postpericardiotomy syndrome (PPS) occurs in 10% to 50% of pediatric patients after cardiac surgery. The incidence and outcome of PPS after permanent pacemaker implantation in children is not described.

Methods

A retrospective analysis was performed of all pediatric patients who underwent isolated placement of a pacemaker between January 1984 and December 2002. Patients who underwent congenital heart surgery at the time of pacemaker implantation were excluded. PPS was diagnosed on the basis of clinical symptoms with echocardiographic confirmation of a pericardial effusion.

Results

Four hundred and forty-three pacemakers (237 epicardial, 206 transvenous) were implanted in 370 patients (median age 10 years, range 2 months to 24 years). Eight (2%) episodes of PPS (6 epicardial, 2 transvenous) occurred in 7 patients. The median time from implantation to PPS was 12.5 days (range 8 to 22 days). Six (75%) episodes followed primary pacemaker implantation, two occurred after subsequent lead revision. Three patients were initially treated with medical therapy (1 nonsteroidal agents, 2 steroids), and 1 required subsequent pericardiocentesis. Five patients underwent initial pericardiocentesis followed by medication. One patient had echocardiographic recurrence of a pericardial effusion 3 weeks after a nonsteroidal taper, with resolution after nonsteroidal agents were reinitiated. One patient required a pericardial window for a persistent effusion. No pacemaker was explanted.

Conclusions

PPS occurred in 2% of children undergoing isolated pacemaker implantation of both epicardial and transvenous systems. PPS is usually managed successfully with medical therapy. Patients with medical treatment failure were successfully treated with pericardiocentesis or the surgical creation of a pericardial window.