目的：探索分析高龄患者植入永久性心脏起搏器的临床治疗效果。方法180例因缓慢性心律失常植入永久性心脏起搏器的高龄患者作为研究对象,按照植入起搏器类型的不同将180例患者分为单腔起搏器组(120例)和双腔起搏器组(60例)。观察患者手术完成情况、术中情况、术后并发症和病死率等临床指标,评价治疗效果。结果180例缓慢性心律失常高龄患者均成功植入心脏起搏器。两组患者在心房、心室的起搏手术中,起搏器电极值均5 mV, A波振幅均>2 V。仅1例患者在手术中发生急性肺水肿,行经呋塞米静脉注射,该患者病情有所好转；2例患者因神经过度紧张,不能配合正常手术,经地西泮肌内注射后成功完成手术。双腔起搏器组60例患者中,2例患者术后发生气胸症状,其在术前均多次进行锁骨下静脉穿刺手术,60例患者术后无明显并发症,均无心脏穿孔、囊袋血肿感染及切口不愈合等症状。术后1~12个月进行随访,180例患者中2例患者死亡,其中1例年龄83岁,于出院后1个月大面积脑梗死,最终死亡；1例为102岁高龄患者,患者手术3周后因病发急性肺水肿与急性肾衰竭,最终死亡。单腔起搏器组的120例患者中,15例(12.5%)患者术后出现心力衰竭；双腔起搏器组60例患者中,8例(13.3%)患者术后出现心力衰竭,比较差异无统计学意义(P>0.05)。两组患者头晕、乏力等症状基本消失,胸闷、气急等症状显著好转,活动能力明显改善,180例患者均无电极脱位、断裂,起搏器综合征等术后症状。结论高龄患者植入永久性心脏起搏器的临床疗效显著,置入方法简单安全,相比于锁骨下静脉植入,从腋静脉植入心脏起搏电极极大地减少了患者出现气胸、挤压综合征等不良症状,高龄患者植入永久性心脏起搏器具有可行性,值得推广应用。“,”ObjectiveTo investigate clinical effect by permanent cardiac pacemaker implant in senile patients.MethodsA total of 180 senile patients with chronic arrhythmia, who received permanent cardiac pacemaker implant, were taken as study subjects. They were divided by different types of implanted pacemaker into single chamber pacemaker group (120 cases) and dual chamber pacemaker group (60 cases). Observation was made on operation completion, intraoperative condion, postoperative complications, mortality rate in patients to evaluate curative effect.ResultsAll the 180 senile patients with chronic arrhythmia received successful implant of cardiac pacemaker. Both groups had cardiac pacemaker electrode 5 mV, A wave intracavity > 2 V during atrial and ventricular pacing operation. There was only 1 case with intraoperative acute pulmonary edema, which was relieved after intravenous injection of furosemide. There were 2 uncooperative cases due to hypertension, who received successful operation after intramuscular injection of diazepam. Among 60 cases in dual chamber pacemaker group, there were 2 cases with postoperative pneumothorax, who received multiple subclavian vein puncture before operation. All 60 cases had no obvious complications and no symptoms of cardiac perforation, pocket hematoma infection and incision nonunion. Follow-up was made in postoperative 1~12 months. There were 2 death cases among 180 patients, 1 case among them aging 83 years old died due to massive cerebral infarction in 1 month after discharge, and the other case aging 102 years old died due to complicated acute pulmonary edema and acute renal failure in 3 weeks after operation. Among 120 patients in single chamber pacemaker group, there were 15 cases (12.5%) with postoperative heart failure. There were 8 cases (13.3%) with postoperative heart failure in 60 cases in dual chamber pacemaker group. Their difference had no statistical significance (P>0.05). All patients had basically relieved dizzy and weak symptoms, and obviously improved chest distress, flustered and exasperated, and activity of daily living. All 180 patients had no postoperative symptoms of electrode dislocation, fracture, and pacemaker syndrome.ConclusionImplant of permanent cardiac pacemaker in senile patients shows excellent clinical effect, and this method is convenient and safe. Comparing with subclavian vein implant, implant through axillary vein remarkably reduce adverse symptoms of pneumothorax and crush syndrome. Implant of permanent cardiac pacemaker in senile patients shows its feasibility, and it is worth promoting and applying.