心脏起搏器安置术后电极脱位的预防护理

介绍了心脏起搏器安置术后电极脱位的类型、发生率、发生原因及处理．重点综述了安置心脏起搏器术后预防电极脱位的护理。     

永久性心脏起搏器植入术并发症的评估与处理

安置永久性心脏起搏器后不可避免地发生各种各样的并发症,常见的并发症有:电极脱位、囊袋血肿、感染、起搏功能障碍等,术中、术后要密切观察,及时处理。1 临床资料     

自制荞麦小枕在心脏起搏器植入术后的应用

安置永久性起搏器是治疗不可逆的心脏起搏传导功能障碍的安全有效方法,特别是治疗重症缓慢性心律失常。心脏起搏器植入术后为避免创口出血和电极脱位,常规要求平卧24 h,并用     

永久性双腔心脏起搏器植入患者的术后护理

总结了29例永久双腔心脏起搏器植入患者的护理体会。术后护理包括一般护理、预防电极脱位的护理、出血及血肿的护理、起搏器袋囊感染的护理、饮食及其他护理、出院指导。认为对永久性双腔心脏起搏器植入的患者加强术后临床护理,可取得较好的治疗和护理效果。     

永久性心脏起搏器植入术并发症234例分析

目的：回顾分析永久性心脏起搏器植入术并发症，总结种类，分析原因，提出有效的防范措施。方法：回顾分析我院234例永久性心脏起搏器植入患者术后随访情况。结果：起搏器囊袋出血（血肿）3例，起搏器切口裂开1例，电极脱位或微脱位3例，电极断裂2例，室性心动过速导致心源性晕厥1例，电池耗竭导致心室停搏2例。结论：提高对心脏起搏器常见并发症种类的认识，术前准备充分，术中仔细操作，术后严密观察，定期随访，友时发现与处理并发症，可避免引起不良后果及医患纠纷。[著者文摘]     

心脏起搏引起胃肠功能障碍的护理体会

严重的心动过缓性心律失常经植入永久性埋藏式心脏起搏器可获得理想的治疗效果。随着起搏方式的拓宽,临床上会遇到一些以往少见的并发症。我科通过对256例安置心脏起搏器患者的术后护理,就其中11例术后出现胃肠功能障碍（包括1例电极微脱位）的原因进行探讨并将护理体会报告如下：1资料与方法1．l观察对象1994年～1998年在我院植入AAI、VVI、DDD起搏器的心动过缓患者共256例,全部病例均符合理植永久性心脏起搏器的条件[1]。11例在术后3～6h内出现胃肠功能障碍,其中男7例,女4例,年龄（69．8±6．3）岁;安装AAI2例,VVI9例,均有…     

永久心脏起搏器植入术后并发症的原因分析及护理对策

目的探讨永久心脏起搏器植入术后并发症及其原因,并总结护理对策。方法回顾分析2005年1月至2007年2月54例永久心脏起搏器植入术患者的临床和护理资料。结果术后发生并发症9例(11例次),发生率为20.4%(11/54),其中电极脱位5例次(45.4%),囊袋积血3例次(27.3%),起搏器感知功能障碍2例次(18.2%),起搏器综合征1例次(9.1%);所有并发症经相应处理后,患者均恢复正常。结论永久心脏起搏器植入术后并发症以电极脱位和囊袋积血为多见;熟悉永久起搏器植入术相关理论知识、术后密切观察和护理,对预防及减少术后并发症的发生有重要作用。     

心脏起搏器安置术的护理与程控管理

目的总结心脏起搏器安置术的护理及程控管理要点。方法调查65例心脏起搏器安置术患者护理与程控管理中的潜在或存在问题,并进行护理要点的总结。结果术中并发症2例(阿-斯综合征1例,电极导线接错1例),术后并发囊袋积血2例,感染1例,程控不良事件起搏电极移位1例,电极断裂1例,电池耗竭1例,感知不良3例。结论重点加强术中、术后的观察与护理,严防并发症是保障手术成功的关键;不断完善和规范起搏器程控管理,除可及早发现、及时处理不良事件外,更是保证起搏效果,延长起搏器寿命,提高患者生活质量和生命安全的重要措施。     

安置埋藏式心脏起搏器防治感染的护理

感染是安置埋藏式心脏起搏器术后常见的并发症之一,正确的防治感染,是埋藏起搏器成功的关键。我院自1981年1月至1987年10月共安置了经静脉永久性心脏起搏器70例,其中高度～Ⅲ度房室传导阻滞28例,心房颤动并Ⅱ度房室传导阻滞5例,病态窦房结综合征37例。方法为按常规取头静脉或颈外静脉安置心内膜电极,在同一切口下方胸部皮下     

起搏器电极导线脱位的临床因素分析及相应处理策略

起搏电极导线脱位曾是永久心脏起搏器置入术后的常见并发症,随着起搏电极工艺的改进,起搏电极脱位的发生率明显降低。但近年来仍常有因起搏电极导线脱位或微脱位而导致起搏不良或发生不良心血管事件的报道。笔者结合我院发生电极脱位或微脱位的9例患者的临床情况,对电极脱位的相关因素进行探讨,并总结相应的治疗策略。     

Ribbed人工关节全髋置换后的康复训练与护理

目的探讨系统的康复训练特别是术后院外康复训练的重要性。方法对104例全髋关节单侧置换患者进行术后康复指导。术后3个月、6个月以及1年分别对患者功能康复情况进行随访,评估康复效果。结果104例患者Harris评分术前平均34．7分,术后平均92．8分。其中优秀81．3％,良好10．1％,一般4．4％,差3．3％。除1例髋臼松动导致翻修外,影像学检查均无异常。结论对髋关节置换术后患者进行系统的康复训练特别是院外功能康复训练与护理指导,有利于髋关节早日恢复良好状态,提高患者生活质量。     

Elimination of Lead Dislodgement by the Use of Tined Transvenous Electrodes

Pacemaker lead dislodgement has accounted for a large proportion of the postoperative complications seen after transvenous pacemaker insertion. Ninety-two patients underwent implantation of a tined transvenous electrode over a three-year period without a single dislodgement. Excellent thresholds were obtained and no difficulties related to electrode insertion were encountered. Tined transvenous pacemaker leads are preferred for routine use at this time.     

胸膜纤维板剥脱术治疗慢性脓胸23例分析

目的 探讨如何选择胸膜纤维板剥脱术及其改良术式治疗慢性脓胸,并观察疗效.方法 回顾性分析2000至2007年我院采用胸膜纤维板剥脱术治疗23例慢性脓胸患者的疗效.结果 全组采用传统胸膜纤维板剥脱术1例;仅行脏层胸膜12例,脏层胸膜纤维板剥除加壁层纤维网状切开术10例,加作肺叶切除1例.术后脓腔全部消灭,脓胸全部治疗愈,全组无死亡病例.结论 胸膜纤维板剥脱术是治疗慢性脓胸的有效方法.纤维板形成初期由于质地疏松,容易剥脱,宜选传统的胸膜纤维板剥除术将脏、壁层胸膜及脓腔整块切除;病史长者,粘连致密,剥离困难,可选用改良术式,仅作脏层纤维板剥除,壁层胸膜纤维板不作处理或网状切开,亦可达到满意疗效.     

改良医用固定带提高永久起搏器术后的有效固定

目的:改良永久性心脏起搏器植入术后医用固定带,解决术后固定带容易发生移位、滑脱问题。方法:选取镇江市第一人民医院心内科2018年下半年96例接受永久性心脏起搏器植入治疗的患者,观察组使用改良后的医用固定带固定,对照组使用传统医用固定带固定。结果:改良固定带的使用明显提高了患者术后固定有效率,减少了囊袋出血、电极脱位等并发症的发生,大大缩短了包扎时间,两组差异有统计学意义观察组术后6h内、术后6h后固定有效率均为100%,对照组术后6h内、术后6h后固定有效率分别为75.00%,79.17%,差异有统计学意义(P<0.01)。术后并发症囊袋出血观察组发生率为2.08%,对照组为6.25%;术后电极脱位观察组未发生,对照组发生率为2.08%,差异有统计学意义(P<0.05)。两组患者固定带包扎标准时间比较:观察组高效39例(81.25%),中效5例(10.42%),低效4例(8.33%),总标准时间44例(91.67%);对照组高效0例(0%),中效13例(27.08%),低效35例(72.92%),总标准时间13例(27.08%),差异有统计学意义(P<0.05)。结论:永久性心脏起搏器植入术后的患者使用改良后的医用固定带固定,在提高术后固定有效率、减少术后并发症、缩短包扎时间上有显著效果。     

Temporary pacemaker treatment in open heart surgery: variation in myocardial threshold, tissue and interface impedances in man.

Myocardial threshold and impedance of adequately insulated multicore metal electrodes (lengths l1 and l2) were investigated in 28 patients undergoing open heart surgery. Increase in current threshold from the pre-to postoperative period was: 607 +/- 102% (mean +/- SEM) with a constant-current pulse generator and 885 +/- 129% with a constant-voltage pulse generator. Tissue impedance (RT - initial impendance) calculated as voltage/current ratio 90 mus into the pulse changed from 564 +/- 34 omega before surgery to a minimum of 134 +/- 7 omega. Thereafter, there was a gradual increase in RT to 162 +/- 9 omega the day of electrode removal. In 25 of 28 patients the minimum values were reached the third to eighth postoperative day. Electrode/tissue interface impedances--Faraday resistance (RF) and Helmholtz capacity (CH)--were calculated from regression analysis of loaded and unloaded electrograms using the method of least squares. The RF showed a fall from 14.7 +/- 1.4 K omega to 5.2 +/- 0.3 K omega, and the CH (20-40 Hz) rose from 6.0 +/- 0.9 mu F to 15.5 +/- 0.8 muF preoperatively to the day of minimum tissue impedance. There were no further changes until the day of electrode removal. A significant positive correlation was found between CH (p < 0.002), current threshold (p < 0.005) and equivalent electrode length [lequ = l1 X l2/(l1 + l2)]. The electrode signal source impedance calculated from RT, RF and CH was of a magnitude not likely to contribute to demand failures. The low postoperative electrode impendance resulted in excessive load on the constant-voltage generator (condenser discharge type), rendering stimulation of the heart with reasonable current values impossible.     

The High Impedance Dish Electrode—Clinical Experience with a New Tined Lead

To reduce current drain and thus optimize pulse generator longevity, 25 unipolar trailing tined leads with a 6 mm² platinum electrode shaped as a dish were implanted in suitable patients and compared to a patient series in which 25 standard unipolar trailing tined leads with an 8 mm² standard platinum electrode were implanted. Comparing the two patient groups there were no significant differences in age, sex, diagnosis or vein used. Comparing implant data: mean voltage threshold was 0.50 ± 0.13 V (standard deviation) for the group with the dish electrode and 0.60 + 0.14 V for the group with the standard electrode (p < 0.02). The mean current threshold was 0.64 ± 0.18 mA for the dish electrode and 0.88 ± 0.25 mA for the standard electrode (p < 0.001). The mean calculated impedance was 758± 149 ohm for the dish electrode and 598 ± 104 ohm for the standard electrode (P < 0.001). R wave amplitude was a mean of 7.4 ± 4.3 mV (dish electrode) and 7.4 ±3.7mV (standard electrode). There were two deaths; one at twelve months, cause unknown, and the other from a postoperative hemopericardium due to right ventricular perforation from the temporary pacing lead. The only complication was an electrode retraction from the endocardium. In seven patients with dish electrodes, pulse generators able to measure voltage threshold (Vario) non-invasively were used. Mean postoperative voltage thresholds were as follows: 24 hours 0.64 V, 48 hours 0.68 V, two weeks 1.44 V, three months 1.30 V and six months 1.40 V. Thus, at implant the lead with the dish electrode had a significantly higher impedance (21%), lower voltage threshold (17%) and lower current threshold (27%) compared to a standard lead. R wave amplitude was normal. Follow-up voltage threshold Jevels to data suggest that lale high thresholds are unlikely. Thus, the tined lead with the high impedance dish electrode is likely both to reduce lead complications and to improve pulse generator longevity. (PACE, VoJ. 5, July-August. 1982)     

Emergency guide wire pacing: new methods for rapid conversion of a cardiac catheter into a pacemaker

We developed a new electrode to convert rapidly a previously inserted pulmonary artery or left ventricular catheter into a pacemaker. One method of doing this is by withdrawal of the pulmonary artery catheter from the pulmonary artery to the right ventricle by pressure control, and a Teflon-coated guide wire, stripped of 5 mm of insulation at its tip, is advanced through the catheter to contact the endocardium. In the second method, the pacing electrode is advanced through the distal lumen of the catheter while it is positioned within the pulmonary artery and withdrawn into the right ventricle while pacing. Finally, a third Method involves advancement of the guide wire electrode into the left ventricle through a pigtail catheter. To pace, the guide wire electrode is connected to the cathode of a pacemaker referenced to a skin electrode. We paced 10 of 10 right heart cardiac catheterization, intra- and postoperative surgery patients by methods 1 and 2, and 4 of 4 left heart catheterization patients by method 3. Thresholds (mean ± SEM) for guide wire pacing were: right ventricle 1.52 ± 0.4 mA; left ventricle 1.33 ± 0.1 mA. Guide wire pacing is rapid, reliable, and requires little operator skill. Our indications for guide wire pacing are: 1) emergency right ventricular pacing in operative or intensive care unit patients with unexpected bradyarrhythmias who have an indwelling pulmonary artery catheter; and 2) emergency left ventricular pacing in left heart cardiac catheterization patients with contrast-induced bradyarrhythmias.     

Postoperative imaging and evaluation of the electrode position and depth of insertion of multichannel cochlear implants by means of high-resolution computed tomography and conventional X-rays

Following cochlear implantation, postoperative imaging of the electrode is very important in order to measure the depth of insertion and the position of the electrode, so that kinking and incorrect electrode placement can be clearly identified. The aim of this study was to outline the diagnostic value of CT and conventional X-ray for these parameters. For this purpose we obtained radiographs of patients who had received a cochlear implant. Computed tomography was performed by obtaining axial sections. For conventional X-ray we used digital imaging, utilising a modified Chausse III projection. The images were then rated according to electrode position, insertion depth and possible complications. We also measured the radiation dose using a dummy and evaluated the cost of each examination. Both examinations permit excellent identification of electrode position and insertion depth. However, the depth of insertion can be measured much more accurately by means of digital X-ray. The radiation dose of CT was 230 times higher than that of conventional X-ray and the cost of CT 5 times that of digital X-ray.     

对食管电极插管方法的临床探讨

目的 :减少病人痛苦 ,提高插食管电极的成功率。方法 :将 12 6例病人分成喝水组和常规组进行插食管电极对比观察。结果 :喝水组插电极所用的时间和产生恶心次数明显少于常规组。结论 :喝水法插电极符合人体的解剖、生理特点 ,病人痛苦少 ,且容易得到病人的配合 ,是安全、有效、快捷的插管方法。