我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

起搏器植入术后有症状患者起搏参数优化和程控

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第6期
页码:
669-672
栏目:
临床研究
出版日期:
2014-06-25

文章信息/Info

Title:
Parameter optimization and adjustment in pacemaker-implanted patients with clinical symptoms
作者:
李 萍; 宫剑滨; 王立军; 张启高
(南京军区南京总医院心脏内科，江苏 南京 210002)
Author(s):
LI Ping;  GONG Jian-bin;  WANG Li-jun;  ZHANG Qi-gao
(Department of Cardiology, General Hospital, Nanjing Military Area Command, Nanjing 210002, Jangsu, China)
关键词:
心脏起搏器; 临床症状; 起搏参数; 优化; 程控
Keywords:
cardiac pacemaker;  clinical symptoms;  pacing parameter;  optimization;  programmable
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的:回顾性分析心脏起搏器植入术后有症状患者的起搏参数优化和程控。方法： 门诊随访患者324例，随访时根据患者向医生陈述的痛苦表现，如心悸、胸闷等症状，判定为有症状患者138例，其中双腔起搏器（dual-chamber pacemaker,DDD）54例，单腔起搏器（singal-chamber pacemaker,VVI）84例。随访时间为术后当天至16年不等，根据患者的主诉、心电图及起搏器功能检测情况进行参数优化和调整，必要时行X胸片、动态心电图、心脏超声等检查。结果： 在有症状患者中，共检出心房起搏障碍9例（DDD 9例）心房感知障碍2例（DDD 2例）；心室起搏障碍13例（DDD 3例，VVI 10例）；心室感知障碍12例（DDD 5例，VVI 7例）；不适合工作状态31例（DDD 28例，VVI 3例）；房性心律失常50例；室性心律失常12例；三度房室传导阻滞2例，长R-R间期3例。结论： 起搏器植入后需定期随访，通过对其参数的测试、调整和优化，既能有效保障患者安全、延长起搏器电池寿命，还能最大限度地避免和减少患者临床症状的产生，使患者最大获益。
Abstract:
AIM:To explore the parameter optimization and adjustment in pacemaker-implanted patients with clinical symptoms. METHODS: According to the patients’ complaints such as palpitations, chest tightness and other symptoms, 138 cases were deemed as patients with clinical symptoms among the 324 pacemaker-implanted patients followed in the Outpatient Department. Of the 138 patients, 54 were implanted with dual-chamber pacemakers (DDD) and 84 with single-chamber pacemakers (VVI). Follow-up time varied from 1 day to 16 years after implantation. Based on the patients’ complaints, electrocardiographic (ECG) and pacemaker test results, we optimized or adjusted the parameters of the implanted pacemakers. Chest x-ray, dynamic electrocardiography (DCG) and ultrasound cardiography were performed when necessary. RESULTS: In patients with DDD, atrial pacing abnormalities were found in nine cases, ventricular pacing abnormalities in three cases, atrial sensing abnormalities in two cases, ventricular sensing abnormalities in five cases, and inappropriate working status in 28 cases. In patients with VVI, ventricular pacing abnormalities were found in ten cases, ventricular sensing abnormalities in seven cases and inappropriate working status in three cases. Altogether, atrial arrhythmia was found in 45 cases, ventricular arrhythmias in 12 cases, 3rd-degree atrioventricular block in two cases and long period R-R in three cases. CONCLUSION: Adjustment and optimization of the parameters of implanted pacemakers during the regular follow-up after pacemaker implantation can effectively ensure the safety of patients and prolong the battery life of the pacemakers, thus minimizing the patients' clinical symptoms.

参考文献/References

[1]常 瑜,路长鸿,赵玉红,等.人工心脏起搏治疗缓慢性心律失常疗效分析及随访程控[J].中国循证心血管医学杂志,2011,3(1):34-37.
[2]宿燕岗，葛均波.生理性起搏的再认识[J].中国心脏起搏与心电生理杂志,2007,21(3):196-199.
[3]孙长喜.生理性起搏研究进展[J].中国心血管杂志,2008,13(2):136-139.
[4]郭继鸿.最小化心室起搏优势的新证据[J].中国心脏起搏与心电生理杂志,2008,22(4):283-286.
[5]袁晓明,陈厚骧,吴 晞,等.生理性起搏治疗病窦综合症40例随访观察[J].四川医学,2002,23(3):254-255.
[6]Saksena S,Prakash A,Madan N,et al.New generation of implantable pacemaker defibrillators for ventricular and atrial tachyarrhythmias[J].Arch Mal Coeur Vaiss,2006,89(1):149-151.
[7]Sweeney MO,Helkamo AS,Ellenbogen KA,et al.Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with a normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction[J].Circulation,2003,107(23):2932-2937.
[8]海 斯.临床实用心脏起搏与除颤[M].任子文,吴永全，主译.北京:人民卫生出版社,2004:409-410.
[9]Link MS,Estes NA 3rd,Griffin JJ,et al.Complications of dual chamber pacemaker implantation in the elderly.Pacemaker Selection in the Elderly(PACE)Investigators[J].J Interv Card Electrophysiol,1998,2(2):175-179.
[10]郭继鸿.起搏电极导线脱位的临床探讨[J].中国心脏起搏与心电生理杂志,2002,16(1):8-10.
[11]Aydemir O,Ozmen E,Kuey L,et al.Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers[J].Pacing Clin Electrophysiol,1997,20(6):1628-1632.
[12]Leosdottir M,Sigurdsson E,Reimarsdottir G,et al.Health related quality of life of patients with that of pacemaker recipients[J].Europace,2006,8(3):168-174.
[13]徐冬玲,马承恩,王苏加,等.定期随访和起搏器参数程控对心脏起搏患者心理状态的影响[J].山东大学学报(医学版),2008,46(8):781-783.
[14]李 萍，江时森，张 华，等.心脏起搏器植入术后患者临床症状原因分析[J].医学研究生学报,2011,24(3):278-282.

备注/Memo

备注/Memo:
收稿日期：2014-02-05.
作者简介：李萍，副主任医师，硕士Email：zyyliping@sina.com
更新日期/Last Update: 2014-07-10