窦房结功能测定对非心脏手术老年患者临时起搏器的价值

摘要

目的：探讨术前进行窦房结功能测定对非心脏手术老年患者安置临时起搏器的筛选价值，并分析麻醉方式、置入路径等对临时起搏的影响及并发症发生风险的差异。方法纳入2009年10月~2012年10月河北大学附属医院外科住院60岁以上老年患者112例，均为非心脏手术患者，术前心电图示窦性心动过缓、阿托品试验阳性，故均置入临时起搏器，而后再经食管心房调搏（TEAP）判断窦房结功能，主要终点为起搏器在术中是否工作，次要终点为患者的一般资料、麻醉方式、置入途径、并发症等进行总结分析。结果①入组患者中食管调搏检查阳性者48例（42.86%）；②食管调搏阳性患者术中术后起搏比例高于食管调搏阴性患者（70.83%vs.10.94%，P＜0.05）；③所有患者按照麻醉方式分类后发现不同麻醉方式下术中术后起搏比例无统计学意义（全身麻醉起搏vs.连续硬膜外麻醉起搏vs.局部浸润麻醉：35.42%vs.31.25%vs.28.57%，P＞0.05）；④不同临时起搏器置入方式的并发症发生率无统计学差异，未发生假性动脉瘤、心肌穿孔、大出血、心包填塞、感染性心内膜炎等严重并发症。结论术前联合食管调搏评价窦房结功能，对于非心脏手术老年患者可以起到良好的筛查作用，不同麻醉方式对临时起搏器术中术后起搏无影响，临时起搏器置入方式对并发症发生率无影响。%Objective To investigate the screening value of detection of sinus node function to temporary cardiac pacemaker in elderly non-cardiac surgery patients, and analyze the influences of anesthesia methods and inserting routes and difference in risk of complications. Methods The elderly patients (n=112) aged over 60 were chosen from the Affiliated Hospital of Hebei University from Oct. 2009 to Oct. 2012. All patients had undergone non-cardiac surgery, and they were implanted temporary cardiac pacemakers as their ECG showed sinus bradycardia and atropine test showed positive before the operation. The sinus node function was determined through transesophageal atrial pacing (TEAP). The primary endpoint was to determine if pacemakers worked during operation, and secondary endpoint was to sum up and analyze the general data, anesthesia methods, inserting routes of pacemaker and complications. Results ①There were 48 cases (42.86%) showing positive results in TEAP. ②The percentages of pacemaking during and after operation were higher in the patients with positive results in TEAP than that in those with negative results in TEAP (70.83%vs. 10.94%, P<0.05). ③The percentages of pacemaking during and after operation showed no statistical significance after all patients were divided into groups according to anesthesia methods (general anesthesia vs. continuous epidural anesthesia vs. local infiltration anesthesia:35.42%vs. 31.25%vs. 28.57%, P>0.05). ④The incidence of complications, such as pseudoaneurysm, myocaridal perforation, massive hemorrhage, cardiac tamponade and infective endocarditis, had no statistical difference in different routes of pacemaker implantation. Conclusion The reviewing of sinus node function by TEAP has a good screening effect in elderly non-cardiac surgery patients before operation. Different anesthesia methods have no influences on the pacemaking of temporary cardiac pacemakers during and after operation, and the routes of implantation have no influences on the incidence of complications.