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目的总结先天性心脏病(congenital heart diseases,CHD)儿童围术期植入永久性起搏器治疗完全性房室传导阻滞(atrioventricular block,AVB)的经验。方法选择需植入永久起搏器CHD患儿23例,男13例,女10例。年龄4个月~8岁,平均(2.8±2.5)岁,体重5~27 kg,平均(10.7±6.8)kg。结果植入心内膜起博器7例、心外膜起博器16例。起搏方式为频率应答心室按需起搏(VVIR)1例,固定频率心室按需起搏(VVI)22例,起搏频率为70~160次/min,平均(111±25.5)次/min,起搏阈值为0.5~0.75V,平均(0.74±0.30)V,感知灵敏度为2.5~2.8 mV,平均(2.78±0.11)mV,电极阻抗为271~726Ω,平均(445.5±148.9)Ω。21例(91.3%)获得随访,随访1个月~5.5年,起搏阈值术后早期略升高,后稳定。1例术后6个月猝死,原因不明。1例术后4.5年重新更换电池。1例随访中恢复窦性心律。4例术后6个月~2年心脏扩大、心功能低下,左室射血分数(LVEF)<50%。结论 CHD患儿围术期植入永久性起搏器治疗AVB是安全可行的,永久起搏器植入对其远期预后的影响需要长期随访。
Objective To summarize the experience of perioperative implantation of permanent pacemaker in children with congenital heart diseases (CHD) for treatment of atrioventricular block (AVB). Methods Twenty-three CHD children with permanent pacemaker implantation were selected, including 13 males and 10 females. Aged 4 months to 8 years old, with an average of (2.8 ± 2.5) years old and weighing 5-27 kg (mean, 10.7 ± 6.8) kg. Results Implantation of endocardial pacemaker in 7 cases, epicardial pacemaker in 16 cases. The pacing mode was frequency response ventricular pacing (VVIR) in 1 case, fixed frequency ventricular on-demand pacing (VVI) in 22 cases, pacing rate was 70 ~ 160 beats / min, mean (111 ± 25.5) beats / min The average sensitivity was 2.5-2.8 mV (average 2.78 ± 0.11) mV. The impedance of the electrodes was 271 ~ 726Ω with an average of (445.5 ± 148.9) Ω. Twenty-one patients (91.3%) were followed up for 1 month to 5.5 years. The pacing threshold was slightly increased in the early postoperative period and then stabilized. One patient died suddenly 6 months after surgery for unknown reasons. 1 case after 4.5 years to replace the battery. One case was followed up sinus rhythm. Four cases had cardiac enlargement, cardiac dysfunction, and left ventricular ejection fraction (LVEF) <50% at 6 months to 2 years after operation. Conclusion The perioperative implantation of permanent pacemaker in children with CHD is safe and feasible. Long-term follow-up of permanent pacemaker implantation on its long-term prognosis is needed.