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20例埋藏式心脏复律除颤器安置技术总结 |
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任自文 宋有城 胡大一 张金荣 马虹 葛堪忆 杜雪平
朱俊 丁燕生 杨新春 商丽华 王青 郭静萱
【摘要】 目的 总结20例埋藏式心脏复律除颤器(ICD)的安置经验。方法 总结分析20例患者的一般临床情况、手术技巧、心室颤动(室颤)的诱发及除颤阈值(DFT)测定方法以及ICD的程控原则。结果 20例患者中男18例, 女2例; 平均年龄54.1±14.4岁; 冠心病11例, 扩张型心肌病2例, 房缺修补术后1例，右室发育不良2例, 原发性室颤1例, 无器质性心脏病者3例；19例术前均接受胺碘酮治疗, 1例服用索他洛尔。手术全部采用单切口, ICD埋于胸大肌下, 电极导线于切口内经锁骨下静脉穿刺送入右心室。首选T波同步电击法诱发室颤, 成功率 80%。DFT18.4±4.7J, 1例对调电击极性、1例加用上腔静脉电极后DFT才符合要求。电击阻抗53.7±7.6Ω。R波振幅12.4±6.0mV, 1例因R波振幅低而加用心室螺旋电极。 起搏阈值0.6±0.2V。 起搏阻抗540.0±110.8Ω。1例与单极起搏器合用, 术中测试无相互影响。结论 胸部单切口置入ICD方法简便可靠, 术中需酌情决定上腔静脉电极及心室螺旋电极的使用, T波同步电击是一种安全有效的诱发室颤方法。ICD与起搏器合用时，术中需测定二者的相互影响。
【关键词】 除颤器, 植入型 心动过速, 室性 心室颤动
Implantation techniques of 20 implantable cardioverter -defibrillators
Ren Ziwen, Song Youcheng, Hu Dayi, et al. The First Hospital of Beijing Medical University, Beijng 100034
【Abstract】 Objective To summarize the experience of implantation of imptanlable cardioverter-defibrillator (ICD) in 20 patients. Methods The general clinical status, skills of procedures, the methods of inducing ventricular fibrillation (Vf) and measuring defibrillation threshold (DFT), and the principles of programming ICD were analyzed in 20 cases. Results Eighteen males, two females; the average age was 54.1±14.4 years old; eleven patients with coronary heart disease, two with dilated cardiomyopathy, one with repaired atrial septal defect, two with right ventricular desplasia, one with primary Vf, three without organic heart diseases. Nineteen patients took amiodarone and one took sotalol before procedures. Single chest incision procedures were performed in all cases, ICDs were implanted under pectoralis major and the electrode leads were introduced to the apexes of right ventricles by puncturing subclavicular veins. T wave synchronous shock were used to induce Vf at first in all cases and success rate was 80%. DFT 18.4±4.7J.DFT was qualified after reversi[1] [2] [3] 下一页
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