左心室四极与传统起搏导线起搏参数比较

目的比较左心室四极与传统单、双极起搏导线在心脏再同步治疗(CRT)中的起搏参数,探讨左心室四极起搏导线的优势。方法选择自2014年1月至2015年1月我院收治的18例行CRT心力衰竭(HF)患者,应用左心室四极导线与传统起搏导线,分析起搏参数包括:左心室起搏阈值、膈神经刺激(PNS)和心尖部起搏比例。结果本研究18例患者,应用左心室四极起搏导线均可避开高阈值左心室起搏。左心室四极起搏导线与单、双极起搏导线临床PNS发生率分别为5.6%、27.8%和11.1%。所有患者均无因PNS而行左心室导线重置。左心室四极起搏导线与传统单、双极左心室起搏导线比较,左心室心尖部起搏比例分别下降了44.4%和27.7%,差异有统计学意义(P<0.05)。结论左心室四极起搏导线可以有效解决因PNS而进行左心室导线重置及高阈值起搏问题,并降低了左心室心尖部起搏比例。     

起搏器更换时原心脏电极参数的变化及临床意义

目的　总结 18年来更换心脏起搏器时对电极参数测定结果 ,以判断电极能否继续使用提供临床经验。临床资料　 1986年 3月～ 2 0 0 3年 5月 ,38例在起搏器置入术及更换术时 ,用起搏器分析仪直接测量电极参数。心室电极在体内埋置时间为 4～ 11年 (平均 8.4年 )。置入时起搏阈值为 0 .6 4± 0 .37(0 .3～1.5 )V ,更换起搏器时起搏阈值为 1.78± 0 .73(1.0～ 3.6 )V ,更换起搏器时起搏阈值明显高于置入时的 2 .4 5倍 (P <0 .0 0 1) ,增加绝对值为 0 .1～ 2 .6V。置入时和更换时电极阻抗分别为 (6 47.5 2± 178.4 1) (35 0～980 )Ω和 (72 3.2 2± 10 3.30 ) (4 5 2～ 130 0 )Ω ,两者相比P >0 .0 5。本组更换新电极 6例 ,均为阈值明显升高 (>3.5V) ,或 /和电极阻抗过高或过低。结论　①本组电极置入后平均 8.4年 ,更换起搏器时 ,起搏阈值为 (1.78± 0 .73) (1.0～ 3.6 )V ,为置入时的 2 .4 5倍 ,但 30例 (80 % )的起搏阈值 <2 .5V。②起搏器更换时 ,原电极阻抗与首次置入时相比 ,总体上略有升高 ,但无统计学意义 ,近 90 %的电极阻抗在正常范围内 ,2例阻抗 >12 5 0Ω ,进行了电极更换。③更换起搏器时 ,电极参数如起搏阈值在 2 .5V以下 ,电极阻抗在 30 0～ 10 0 0V内 ,自主心律的R波振幅 >2 .5V ,原电极可继     

右心室起搏电极导线穿孔至左心室1例

<正>1临床资料患者男性,62岁。因乏力,气短3年入院。既往有明确的3度房室传导阻滞的病史3年,体型偏瘦,体质量45 kg。入院后,完善相关检查后行双腔永久起搏器植入(ST Jude Victory 5816),将右心室主动电极导线植入于室间隔(图1a,b)。术后2个月,患者主诉头晕再发、心率减慢来院就诊。心电图显示,右心室不起搏,右心房电极起搏感知良     

应用血管内反推力牵引技术拔除35根永久性起搏电极导线

随着心脏起搏技术的广泛应用,起搏器术后顽固感染的发生率逐年增加.特别是对于二次更换起搏器的患者,感染的发生率更高,常常经反复多次清创、换药,仍不能彻底解决,部分患者还出现了严重的菌血症.有效的治疗方法是将已被污染的电极导线取出体外[1,2].     

拔除废用起搏电极的准备与配合

随着心脏介入检查的发展，起搏器应用日益增多，而起搏电极损坏、疲劳或感染后的拔除就显得愈来愈重要了［１］。我科在１９８７～１９９６年期间采用术前充分准备，术中医护密切配合，成功地拔除了感染或更换起搏器的废用电极７例和废用电极导管滑入右心室１例，现介绍如下。１　临床资料８例患者均为男性，年龄３７～７０岁，平均４９．５±９．６岁。起搏电极置入右心室内１１月～１１年（平均７．６年）。柱状电极３例，伞状电极４例。废弃原因：起搏器皮肤感染５例；起搏电极绝缘膜损坏或更换起搏器３例，其中１例废用电极残端脱入右心…     

以异丙肾上腺素为“桥”完成起搏器依赖患者脉冲发生器更换

目的观察起搏器依赖患者以异丙肾上腺素为"桥"行脉冲发生器更换的可行性。方法术中起搏器依赖患者静滴异丙肾上腺素,诱发出内在节律后行脉冲发生器更换,不能诱发出内在节律者植入临时起搏电极,然后行脉冲发生器更换。结果自2009年至2014年,有17例符合起搏器依赖行脉冲发生器更换的患者。静滴异丙肾上腺素后,14例(82%)患者显露出内在节律,完成了脉冲发生器更换;3例(18%)未诱发出内在节律,植入临时起搏电极后完成脉冲发生器更换。在静滴异丙肾上腺素期间,患者血流动力学稳定,无不良反应。结论起搏器依赖患者,以异丙肾上腺素为"桥"行脉冲发生器更换是可行的,可以减少临时起搏电极植入。     

左室电极导线植入不同冠状静脉分支血管与 左室起搏部位关系

目的探讨左室电极导线植入在不同冠状静脉分支血管与左室起搏部位的关系。方法回顾性分析自2011年1月至2015年12月在北部战区总医院因心力衰竭植入心脏再同步治疗起搏器或心脏再同步治疗除颤器的112例患者的临床资料。分析术中留取的左前斜45°及右前斜30°冠状静脉逆行造影影像,按冠状静脉分支走向将植入血管分为心大静脉、左室前侧静脉、左室侧静脉、左室后静脉、心中静脉。右前斜30°将左室起搏部位三等分为心尖部起搏、左室中部起搏和基底部起搏,并将心尖部起搏归类为左室心尖部组(n=22),左室中部和基底部起搏共同归类为左室非心尖部组(n=90)。分析两组植入冠状静脉各分支情况。结果 112例患者左室电极所植入各冠状静脉分支分别为心大静脉2例(1.8%)、左室前侧静脉9例(8.0%)、左室侧静脉85例(75.9%)、左室后静脉14例(12.5%)、心中静脉2例(1.8%)。其中,左室心尖组植入左室前侧静脉1例(4.5%)、左室侧静脉13例(59.1%)、左室后静脉8例(36.4%);左室非心尖组植入心大静脉2例(2.2%)、左室前侧静脉8例(8.9%)、左室侧静脉72例(80.0%)、左室后静脉6例(6.7%)、心中静脉2例(2.2%)。电极导线植入后静脉分支位于心尖部比例高达57.1%(8/14),植入侧静脉分支位于心尖部的比例仅15.3%(13/85);非心尖部起搏的患者植入靶血管大多数分布在左室侧静脉、左室前侧静脉。结论左室单极或双极电极导线植入左室后静脉更容易起搏心尖部。     

无导线起搏器治疗三度房室传导阻滞1例的护理

<正>1临床资料患者女,47岁。因“反复胸闷、乏力伴头晕2年余”于2020年12月入院。心电图示,心房颤动、高度房室传导阻滞,既往有风湿性心脏病史,2008年行二尖瓣机械瓣置换、三尖瓣成形术,2020年11月行三尖瓣置换术,长期口服抗凝药物。入院后完善相关检查后确定患者具有单腔起搏器植入适应证,但采取传统方法植入起搏器,术后伤口愈合困难,     

阔面电极体外无创心脏起搏18例

自80年代以来对体外无创起搏方法的不断改进，阔面电极起搏法因其致颤电流与最小电流之比平均为12．6：1，在起搏电流强度下不会诱发各种恶性心律失常，对心肌酶也无明显影响，在紧急情况下临床应用较多。1996—2000年我科共用阔面电极体外无创起搏18例，起搏效果较好，现将资料报告如下。     

紧急床边无漂浮电极的心内膜临时起搏42例临床分析

20 0 0年 6月～ 2 0 0 2年 6月我科采用无漂浮电极行床边临时起搏治疗 4 2例患者 ,取得了较好疗效 ,现报道如下。1　资料和方法1.1　一般资料　 4 2例患者中 ,急诊抢救室 2 6例、ICU病房 2例、冠心病监护病房 6例、手术室 4例、其他病房 4例 ;男 2 8例 ,女 14例 ,平均年龄 5 8.     

心脏起搏器电极脱位的原因和处理

目的 随访安装起搏器患者，观察起搏电极的情况，探讨电极脱位的原因，了解和避免起搏电极的脱位。方法 总结6例起搏器患者的临床资料，电极导线7根8次脱位，其中起搏器DDDR2例、DDD2例、VVI2例。结果 4例右锁骨下静脉穿刺、1例左锁骨下静脉穿刺，1例头静脉置入，心房导管脱位4次、1例微脱位，心室导管脱位4例、2例微脱位，其中3例为老年女性，4根导管5次脱位。结论 在起搏器安装时要采取必要的措施预防电极脱位，尤其要警惕老年女性或肥胖者。可能老年肥胖女性组织疏松，起搏器由于重力下坠产生遂道，牵拉导管会引起脱位。     

Correlations of left ventricular diastolic parameters and heart rate: assessment through right ventricular pacing

This study evaluated the correlations between left ventricular (LV) diastolic parameters assessed by equilibrium radionuclide angiography (ERNA) and heart rate (HR) through right ventricular pacing. Twelve patients with a permanent right ventricular apex pacemaker were included. Serial ERNA studies were performed under 6 sets of pacing cycle length (heart rate=52, 62, 72, 82, 92, 104 beats/min) for each patient. The left ventricular ejection fraction was 49.9%±3.1 under pacing HR of 52 bpm and 43.8 %±3.1 % under pacing HR of 104 bpm. The peak filling rate (PFR) increased very significantly with HR (r=0.98, P < 0.001). When the relative changes of end-diastolic volume were taken into account, the correlation between PFR and HR remained significant (r=0.94, P <0.001). The absolute time to PFR (TPFR) did not significantly change with HR, but the ratio of TPFR to cycle length strongly correlated with HR. Our study clearly demonstrates that the PFR assessed by ERNA increases and the TPFR occupies an increasing proportion of the cycle length as HR increases. Therefore, LV diastolic parameters should be normalized for HR in clinical applications. In particular, HR changes should be considered when LV diastolic parameters are used for the assessment of therapeutic interventions. Offprint requests to: Z.-X. He     

不同部位起搏对缓慢性心律失常患者的疗效及对其LV相关指标和CQQC评分的影响初步评估

目的 探讨不同部位放置起搏器对缓慢性心律失常患者的疗效及对其左心室(left ventricular,LV)功能和患者生活质量的影响。方法 选取2020年1月-2021年12月海安市人民医院收治的83例缓慢性心律失常的患者,根据永久性起搏器植入的部位分为两组。其中研究组患者43例,采用右心室间隔植入心脏永久性起搏器治疗;对照组患者40例,则采用右心室心尖部植入心脏永久性起搏器治疗,比较两组患者的心功能情况、临床疗效、生活质量等差异。结果 植入术后研究组的左心室射血分数(left ventricular ejection fraction,LVEF)高于对照组,左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)和左心室收缩末期内径(left ventricular end-systolic dimension, LVESD)均低于对照组（P＜0.05）。植入术后研究组的心室机械收缩同步性指标及心肌受损相关指标低于对照组（P＜0.05）。植入术后两组的心脏不良事件发生率比较无差异（P＞0.05）。植入术后两组的生活质量均较术前升高,且研究组更高（P＜0.05）。结论 右心室间隔起搏可更为显著的改善缓慢性心律失常患者的心功能情况,同时不增加术后的并发症发生率,最终改善患者的生活质量。     

Impact of imaging landmark on the risk of MRI‐related heating near implanted medical devices like cardiac pacemaker leads

Implanted medical devices such as cardiac pacemakers pose a potential hazard in magnetic resonance imaging. Electromagnetic fields have been shown to cause severe radio frequency‐induced tissue heating in some cases. Imaging exclusion zones have been proposed as an instrument to reduce patient risk. The purpose of this study was to further assess the impact of the imaging landmark on the risk for unintended implant heating by measuring the radio frequency‐induced electric fields in a body phantom under several imaging conditions at 1.5T. The results show that global radio frequency‐induced coupling is highest with the torso centered along the superior–inferior direction of the transmit coil. The induced E‐fields inside the body shift when changing body positioning, reducing both global and local radio frequency coupling if body and/or conductive implant are moved out from the transmit coil center along the z‐direction. Adequate selection of magnetic resonance imaging landmark can significantly reduce potential hazards in patients with implanted medical devices. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Analysis of the hematological and biochemical parameters related to lead intoxication

In parallel with industrial advancements, number of the occupational diseases secondary to chemical exposure is increasing. The chemical agents in the work places affect various organ and tissue systems, leading to chronic diseases. In this study, the cases diagnosed with occupational disease due to exposure to lead were studied and importance of the environmental forensic sciences on this issue was emphasized. A hundred and ninety patients diagnosed with occupational disease related to lead intoxication in Ankara Occupational Diseases Hospital between 01/01/2009 and 31/12/2009 were included in the study. Twenty cases were used as the controls. Sociodemographic characteristics, serum chemical parameters and hematological parameters of the patients were retrospectively assessed. Mean age of the cases included in the study was 35.3 ± 8.69. Hemoglobin (Hb) (p = 0.018) and Mean corpuscular volume (MCV) (p < 0.001) values were found significantly lower in the patients with lead exposure than in the controls. Gamma glutamyl transferase (GGT) was significantly lower in the patients with lead exposure than in the controls (p = 0.002), whereas alkaline phosphatase (ALP) was found higher (p < 0.001). In thyroid function test (TFTs) panel, free triiodothyronine (fT3) levels were found significantly higher in the patients with lead exposure than in the control group (p = 0.01), while Thyrotrophin-stimulating hormone (TSH) levels were lower (p < 0.001). No significant difference was found in terms of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values. In the correlation analysis; serum level of serum lead (Pb) was correlated positively with ALP values and negatively with Hb, MCV and TSH. Considering its effects on the biochemical and hematological parameters, a detailed investigation should be carried out in the cases with lead exposure, which occupies an important place among the occupational diseases.     

老年高血压伴左室肥厚与动态血压参数相关性分析

目的 观察老年高血压伴左室肥厚(hypertension with left ventricular hypertrophy,HLVH)患者24 h动态血压波动的特点,制定相关治疗措施.方法 76例老年高血压患者根据心脏多普勒超声结果分为高血压伴左室肥厚组(HLVH)35例、单纯高血压组(NHLVH)41例,采用动态血...     

An automated measurement system for characterization of RF and gradient coil parameters

A fully automated laboratory-based measurement system for characterization of coil system parameters is presented. This method uses an inexpensive personal computer (PC)-controlled stepper motor positioning system in conjunction with a network/spectrum analyzer and an analog-to-digital converter (A/D) board that allows high resolution data acquisition in an unattended manner. A graphical interface was created for complete control of stepper motor movement, measurement, and data acquisition. The system is capable of performing a wide range of measurements that can, either individually or combined, characterize radiofre-quency (RF) and gradient coils used in MRI. Measurement methods, theory, and results for conductor and shield current distributions, mutual impedance, and magnetic fields are given. Comparisons with theoretical calculations are included to validate the accuracy and utility of the system.