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本文报告应用人工心脏起搏治疗严重缓慢型心律失常病人159例,共安置按需型起搏器200例次。应用佩带式者31例,埋置式128例。其中以冠心病、慢性心肌炎和心肌病伴有阿—斯综合征发作者居多。心电图表现为三度或莫氏Ⅱ型二度房室传导阻滞,病窦综合征,双侧束支阻滞等。结果在31例应用佩带式起搏者中,有6例于手术后数天至一年内因起搏失势而死亡,均发生在开展心脏起搏工作的早期;12例可停用心脏起搏治疗,13例因需继续起搏治疗而更换埋藏式心脏起搏器。128例应用埋置式起搏者中,有6例于起搏治疗后2个月～3年之间死亡。术后并发症有心内膜电极早期或晚期脱位,皮囊感染和裂开,电极导线折断,脉冲发生器脱疆,按需功能失常及电能过早耗竭等。本文最后对心脏起搏治疗的并发症,适应症及随访工作的意义等方面进行了讨论。此外,对Q—T延长综合征并发扭转型室速的起搏治疗,病窦综合征病例中埋置可调式按需起搏器等问题亦提出一些见解。
This article reports the use of artificial cardiac pacing in the treatment of 159 patients with severe arrhythmia, a total of placement on demand pacemaker 200 cases. 31 cases were worn and 128 were buried. Among them, coronary heart disease, chronic myocarditis and cardiomyopathy accompanied by Alzheimer’s syndrome were the most. ECG showed three degrees or Mohs Ⅱ second degree atrioventricular block, sick sinus syndrome, bilateral bundle branch block and so on. Results Of the 31 patients with wear-induced pacemaker, 6 died of pacing loss within days to one year after surgery, all of which occurred in the early stage of cardiac pacing. In 12 patients, cardiac pacing was discontinued , 13 cases due to need to continue pacing treatment and replace the buried cardiac pacemaker. Sixty of 128 patients undergoing ambulatory pacing died within 2 months to 3 years after pacing therapy. Postoperative complications include early or late dislocation of the endocardial electrode, skin infection and dehiscence, electrode lead breakage, pulse generator depolarization, on-demand dysfunction, and premature depletion of electrical energy. Finally, this article discusses the complications, indications and significance of follow-up of cardiac pacing therapy. In addition, Q-T extended syndrome complicated by torsades de pointes pacemaker treatment, sick sinus syndrome cases embedded adjustable pacemaker and other issues also raised some insights.