本文選題：臨時(shí)起搏器 + 非心臟外科手術(shù)　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 在非心臟外科手術(shù)的患者中,時(shí)常有些患有冠心病、竇性心動過緩、房室傳導(dǎo)阻滯的患者,手術(shù)時(shí)需安置臨時(shí)起搏器渡過術(shù)中風(fēng)險(xiǎn)。但在部分患者中,臨時(shí)起搏器在圍手術(shù)期中并未發(fā)揮起搏功能,且安裝臨時(shí)起搏器存在靜脈穿刺損傷、心臟內(nèi)導(dǎo)聯(lián)的機(jī)械刺激作用、起搏器導(dǎo)聯(lián)的電活動、血腫、感染或血栓形成、起搏失敗等一系列并發(fā)癥,增加了病人的風(fēng)險(xiǎn),且造成醫(yī)療資源的浪費(fèi)。本文通過回顧性分析非心臟手術(shù)前安裝臨時(shí)起搏器治療的患者多項(xiàng)臨床資料,評價(jià)臨時(shí)起搏器在術(shù)中和術(shù)后的使用情況,為臨床圍術(shù)期臨時(shí)起搏應(yīng)用提供參考。 方法 選擇我院非心臟外科手術(shù)前安裝臨時(shí)起搏器的緩慢性心律失�；颊�274例,根據(jù)術(shù)中起搏器工作情況,分為起搏組與備用起搏組,其中起搏組90例,備用起搏組184例,用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)分析,比較上述指標(biāo)的水平在組中差異是否有統(tǒng)計(jì)學(xué)意義(以P0.05為差異有統(tǒng)計(jì)學(xué)意義)。 結(jié)果 不同心律失常下起搏器工作情況不同,合并竇緩及Ⅲ度AVB、房顫伴長間歇、快慢綜合征的患者臨時(shí)起搏器工作狀態(tài)多(P0.05),而合并Ⅱ度AVB、雙束支阻滯、完全左后分支阻滯、完全性左束支阻滯的患者臨時(shí)起搏器工作狀態(tài)較少(P0.05)。不同年齡階段起搏器工作情況不同,年齡大于70歲的緩慢性心律失�；颊咝g(shù)中臨時(shí)起搏器工作狀態(tài)多(P0.05),年齡小于70歲的緩慢性心律失�；颊咝g(shù)中臨時(shí)起搏器工作狀態(tài)少(P0.05)；合并不同心臟疾病時(shí)起搏器工作狀態(tài)不同,其中在合并擴(kuò)心病、病毒性心肌炎等情況時(shí)起搏器工作狀態(tài)明顯較高(P0.05),而在合并冠心病(穩(wěn)定性心絞痛)、高心病時(shí)的起搏器的工作狀態(tài)較少(P0.05)。麻醉方式對臨時(shí)起搏器工作狀態(tài)無影響(P0.05)。中小手術(shù)臨時(shí)起搏器工作狀態(tài)少,而大手術(shù)時(shí)高(P0.05)。 結(jié)論 1.對于合并有嚴(yán)重竇緩(心率50次/分)及Ⅲ度AVB、雙束支阻滯、房顫伴長間歇、快慢綜合征的患者,術(shù)前植入臨時(shí)起搏器可降低手術(shù)中危及生命的緩慢性心律失常的發(fā)生,使手術(shù)順利進(jìn)行。 2.對年齡大于70歲且合并心臟基礎(chǔ)疾病的緩慢性心律失常患者術(shù)前植入臨時(shí)起搏器可降低術(shù)中惡性心律失常事件的發(fā)生,合并有擴(kuò)心病、病毒性心肌炎的患者術(shù)前植入臨時(shí)起搏器可有效預(yù)防惡性心律失常事件的發(fā)生；對于合并有冠心病、高血壓性心臟病的患者術(shù)前植入臨時(shí)起搏器保護(hù)意義不大。 3.雖然全身麻醉下臨時(shí)起搏器工作狀態(tài)所占比例較局部麻醉和腰麻高,但麻醉方式對臨時(shí)起搏器工作狀態(tài)的影響無統(tǒng)計(jì)學(xué)差異。 4.中小手術(shù)臨時(shí)起搏器工作狀態(tài)少,而大手術(shù)時(shí)高。 老年患者行非心臟手術(shù)前,如果存在以下情況時(shí),不論手術(shù)大小、麻醉方式如何,最好先行臨時(shí)起搏器植入術(shù)：(1)嚴(yán)重竇性心動過緩及Ⅲ度房室傳導(dǎo)滯；(2)房顫伴長間歇(2s)；(3)快慢綜合征。當(dāng)患者存在如下情況并合并擴(kuò)心病、病毒性心肌炎時(shí),在行大手術(shù)、全麻時(shí)可先行臨時(shí)起搏器植入術(shù)以保證手術(shù)安全：Ⅱ度房室傳導(dǎo)阻滯、雙束支阻滯、完全左后分支阻滯。
[Abstract]:objective
In non heart surgery patients, some patients suffering from coronary heart disease, sinus bradycardia, atrioventricular block patients, surgery need temporary pacemaker through intraoperative risk. But in some patients, temporary pacemaker pacing does not play a function in the perioperative period, and the installation of temporary pacemaker venous puncture injury. The inside of the heart lead mechanical stimulation, electrical activity, pacemaker leads hematoma, infection or thrombosis, pacing failure and other complications, increase the patient's risk, and cause the waste of medical resources. This article through retrospective analysis of clinical data of patients with multiple non cardiac surgery before the installation of temporary cardiac pacemaker therapy, evaluation of temporary pacemaker the use of intraoperative and postoperative, to provide reference for clinical perioperative application of temporary pacing.
Method
Our hospital non heart surgery before the installation of temporary pacemaker in patients with slow arrhythmia in 274 cases, according to the work of pacemaker, divided into pacing group and alternate pacing group, including 90 cases of pacing group, alternate pacing group 184 cases, using SPSS18.0 software for statistical analysis, comparing the indicators of the level differences in the group whether there is statistical significance (with P0.05 as the difference was statistically significant).
Result
Pacemaker arrhythmia under different situation is different, complicated with sinus bradycardia and third degree AVB, atrial fibrillation with long interval, patients with temporary pacemaker working state speed syndrome (P0.05), and more patients with degree AVB, bifascicular block, complete left bundle branch block, complete left bundle branch block with temporary pacemaker less states (P0.05). Different age stages of pacemaker is different, older than 70 years of temporary pacemaker arrhythmia in patients with multiple working conditions (P0.05), younger than 70 years of temporary pacemaker arrhythmia in patients with less working state (P0.05) with different cardiac pacemaker working status; when the disease is different, in patients with DCM cases of viral myocarditis and pacemaker working status was significantly higher (P0.05), and in patients with coronary heart disease (stable angina), high heart disease pacemaker work. A few states (P0.05). No effect of anesthesia on temporary pacemaker state (P0.05). Primary and secondary surgery temporary pacemaker working status, and operation of high (P0.05).
conclusion
1. for patients with severe sinus bradycardia (50 BPM) and third degree AVB, bifascicular block, atrial fibrillation with long interval, the speed of syndrome patients, preoperative pacemaker placement can reduce the incidence of life-threatening arrhythmia surgery, make the operation smoothly.
2. of older than 70 years with heart disease arrhythmia patients before implantation of pacemaker can reduce intraoperative arrhythmia events associated with dilated cardiomyopathy and viral myocarditis patients before implantation of pacemaker can effectively prevent malignant arrhythmia events for patients with coronary heart disease, hypertension; heart disease patients before implantation of pacemaker protection has little significance.
3. although the temporary pacemaker working state of general anesthesia is the proportion of local anesthesia and spinal anesthesia, but no significant difference between the effects of anesthesia on temporary pacemaker working status.
4. small surgery temporary pacemaker working status and less operation.
Elderly patients undergoing non cardiac surgery, if the following conditions exist, regardless of the size of operation, anesthesia, the best first temporary pacemaker implantation: (1) severe sinus bradycardia and atrioventricular delay; (2) atrial fibrillation with long interval (2S); (3) the speed of syndrome. When the patients have the following situation and combined with DCM, viral myocarditis, in major surgery, general anesthesia can advance temporary pacemaker implantation in order to ensure the safety of operation: second degree atrioventricular block, bifascicular block, completely left posterior fascicular block.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R654.2

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 傅萬穎;賴漢齊;賴業(yè)旺;;臨時(shí)起搏器在合并不同心臟疾病非心臟手術(shù)中的臨床應(yīng)用比較[J];嶺南急診醫(yī)學(xué)雜志;2016年02期

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本文編號：1754607