论文部分内容阅读
目的 通过对 2 1例植入埋藏式心脏复律除颤器 (ICD)的临床应用分析 ,探讨ICD在恶性室性心律失常中的治疗作用、参数设定、并发症及随访结果。方法 2 1例均植入成功 ,其中单腔ICD 18例 ,双腔ICD 3例。心室起搏阈值 0 3～ 0 9(0 6 8± 0 2 1)V ,R波振幅 5 5～ 2 0 (10 0± 3 8)mV ,除颤阻抗 14～ 73(5 0 2±9 3)Ω ,除颤阈值 5～ 15 (12 5± 4 7)V。随访 3～ 5 7(2 5 3± 11 7)月 ,17例接受了成功的ICD治疗 ,2例发生误放电治疗 ,经重新调整参数后未再发生误放电 ,1例出现囊袋血肿 ,经处理好转 ,2例因电池耗竭更换了ICD装置 ,2例死亡 ,其中 1例为自杀 ,另 1例拒绝治疗和随访 ,室颤反复发作死亡。结果 ICD能有效转复恶性心律失常 ,双腔ICD能提高对室性和室上性快速性心律失常的鉴别 ,降低不适当ICD治疗 ;加强随访及时调整参数更能准确识别和治疗快速室性心律失常
Objective To investigate the therapeutic effect, parameter setting, complications and follow-up results of ICD in malignant ventricular arrhythmias by analyzing the clinical application of 21 implanted cardioverter defibrillators (ICDs). Methods Twenty-one cases were successfully implanted, including 18 cases of single-chamber ICD and 3 cases of dual-chamber ICD. The ventricular pacing threshold ranged from 0 3 to 0 9 (0 6 8 ± 0 2 1) V and R wave amplitude ranged from 5 0 to 20 (10 0 ± 3 8) mV and defibrillation impedance ranged from 14 to 73 (50 2 ± 9 3) ) Ω, defibrillation threshold 5 ~ 15 (12 5 ± 4 7) V. Followed up for 3 ~ 57 (2 5 3 ± 11 7) months, 17 patients underwent successful ICD treatment and 2 patients were treated by accidental discharge. No accidental discharge occurred after readjusting the parameters. One patient had capsular hematoma, Two cases of ICD were replaced due to battery exhaustion, two died, of which one was suicide and the other refused treatment and follow-up. Ventricular fibrillation was recurrent deaths. ICD can effectively reverse the malignant arrhythmia, ICD double chamber can improve the differential diagnosis of ventricular tachycardia and arrhythmia, reduce inappropriate ICD treatment; strengthen follow-up and timely adjustment of parameters to more accurately identify and treat rapid ventricular arrhythmia