發(fā)布時(shí)間：2018-11-06 12:49

【摘要】：目的探討兼容磁共振(MRI)心臟植入裝置(CIED)的臨床應(yīng)用及其安全性。方法回顧性分析自2014年6月至2016年11月在浙江大學(xué)附屬第二醫(yī)院心血管內(nèi)科成功植入兼容MRI心臟植入裝置患者437例。收集患者的基本臨床資料、植入CIED信息、隨訪統(tǒng)計(jì)患者術(shù)后48小時(shí)、術(shù)后1、3、6月的起搏導(dǎo)線參數(shù),MRI檢查情況及并發(fā)癥。結(jié)果437例患者,男性246例,女性191例,平均69.1 ± 12.9歲。起搏器置換患者2例,首次CIED植入患者435例,其中15例為植入型心律轉(zhuǎn)復(fù)除顫器(ICD),2例為心臟再同步治療起搏器/除顫器(CRT-P/D)。所有患者術(shù)中無(wú)并發(fā)癥發(fā)生;術(shù)后發(fā)生2例(0.45%)導(dǎo)線移位,24例(5.49%)患者接受MRI檢查,未觀察到相關(guān)不良事件,導(dǎo)線參數(shù)在MRI檢查前后保持穩(wěn)定。術(shù)后48小時(shí)右房及右室感知(右房/右室 3.5±1.9mV/13.2±5.3mV)較術(shù)中(右房/右室 3.1±1.5mV/10.8±6.3mV)增大,差異有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后48小時(shí)右房及右室起搏導(dǎo)線阻抗(右房/右室517 ± 85Ω/602 ± 105Ω)較術(shù)中(右房/右室624 ± 149Ω/740 ±165Ω)明顯下降,差異有統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后48小時(shí)右房起搏閾值(0.79±0.27V)較術(shù)中(1.03 ±0.68)下降,但差異無(wú)計(jì)學(xué)意義(p0.05),右室起搏閾值較術(shù)中未見(jiàn)顯著性變化。起搏導(dǎo)線參數(shù)術(shù)后48小時(shí)及術(shù)后1～6月隨訪未見(jiàn)顯著性變化。結(jié)論兼容磁共振CIED能安全起搏,適應(yīng)特定條件下的MRI檢查,短期隨訪起搏器工作狀態(tài)穩(wěn)定。
[Abstract]:Objective to investigate the clinical application and safety of magnetic resonance (MRI) compatible cardiac implants (CIED). Methods from June 2014 to November 2016, 437 patients with compatible MRI cardiac implants were successfully implanted in Department of Cardiovascular Medicine, second affiliated Hospital of Zhejiang University. The basic clinical data of the patients were collected, CIED information was implanted, and the pacing lead parameters, MRI examination and complications of 48 hours, 1 ~ 3 and 6 months postoperatively were followed up. Results there were 437 patients, 246 males and 191 females, with an average age of 69.1 鹵12.9 years. There were 2 patients with pacemaker replacement, 435 patients with first CIED implantation, 15 patients with implantable cardioverter defibrillator (ICD),) and 2 patients with cardiac resynchronization therapy pacemaker / defibrillator (CRT-P/D). 2 cases (0.45%) were transposed and 24 cases (5.49%) underwent MRI examination. No related adverse events were observed, and the traverse parameters remained stable before and after MRI examination. 48 hours after operation, the perception of right atrium and right ventricle (3.5 鹵1.9mV/13.2 鹵5.3mV) was significantly higher than that during operation (3.1 鹵1.5mV/10.8 鹵6.3mV). The impedance of right atrial and right ventricular pacing conductors (517 鹵85 惟 / 602 鹵105 惟) at 48 hours after operation was significantly lower than that during operation (624 鹵149 惟 / 740 鹵165 惟) (p0.05). The threshold of right atrial pacing (0.79 鹵0.27V) was lower than that of intraoperative pacing (1.03 鹵0.68) 48 hours after operation, but there was no significant difference (p0.05). There were no significant changes in pacing lead parameters 48 hours after operation and 1 ~ 6 months after operation. Conclusion compatible magnetic resonance CIED is safe for pacing, suitable for MRI examination under specific conditions, and stable in working state of pacemakers in short term follow-up.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541

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