高龄老年患者置入起搏器的安全性及可行性研究

摘要

Objective To evaluate the safety and feasibility of implanted pacemaker in elderly patients.Methods From January 2009 to December 2011,a total of 256 cases of primary implanted pacemaker patients were enrolled.According to the age of the defined standards,256 patients were divided into 2 groups:108 cases in old group and 148 patients in young group.Threshold value,perception perioperative and postoperative,puncture complications,electrode dislocation,infection and complications were observed.Results Gender,diabetes,body mass index,atrial pacemaker threshold value and perception,ventricular pacemaker threshold value and perception had no significant differences between 2 groups.The age and the patients with lung diseases in old group were obviously more than those in young group[(84 ±9)old years vs (68 ±7) old years,63.9％ (69/108) vs 10.1％ (15/148),all P ＜ 0.05].The patients with complications in two groups were 13 cases,including 6 cases of young group and 7 cases of old group.The complications associated with implanted pacemaker was 2 cases in young group and 3 cases in old group.The electrode wire related complications included 1 case in each group,and pacemaker related complications were 3 cases in each group; there was no significant differences between two groups (P ＞ 0.05).Conclusion Implanted pacemaker in elderly patients is safe and feasible,but we should understand the characteristics of the elderly patients and pay attention to perioperative and postoperative management.%目的 探讨高龄老年患者置入起搏器的安全性和可行性,以及如何预防其并发症的发生.方法 对2009年1月至201 1年12月共计256例初次置入起搏器患者的临床资料进行回顾性分析,依据年龄不同,分为高龄组(＞ 75岁,108例)和低龄组(60 ～ 74岁,148例).观察术中、术后起搏器阈值、感知情况,随访术中及术后7d、3个月、半年穿刺并发症及电极脱位、感染等并发症发生情况.结果 2组患者性别、糖尿病病史、BMI、心房感知和起搏阈值、右心室感知和起搏阈值等方面差异均无统计学意义(均P＞0.05).高龄组患者年龄、肺部疾病史患者所占比例均明显高于低龄组老年患者[(84±9)岁比(68±7)岁,63.9％(69/108)比10.1％ (15/148)],差异均有统计学意义(均P＜0.05).2组发生并发症共计13例,低年龄组6例,高龄组7例.与起搏器置入相关并发症5例,低龄组2例,1例穿刺过程中出现气胸,1例术后7d内出现囊袋血肿；高龄组3例,1例置入术后24h出现气胸,1例置入过程中出现血气胸,1例术后5个月发生起搏器感染.与电极导线相关并发症2例,低龄组和高龄组各1例.与起搏器相关并发症6例,其中低龄组3例,分别为电池提前耗竭2例,起搏器综合征1例；高龄组3例,分别为起搏器移位2例,起搏器感知、起搏功能障碍1例.2组并发症发生情况比较,差异无统计学意义(P＞0.05).结论 高龄患者置入起搏器安全可靠,但同时要了解高龄老年患者的特殊性以及注意围手术期管理.