摘要
目的 探讨临床永久起搏器植入术围手术期并发症及其护理，为围手术期并发症的诊疗提供指导。方法 对我院近2年来植入永久起搏器639例住院患者，进行回顾分析其围手术期并发症的发生及转归。结果 围手术期发生囊袋血肿6例、囊袋感染2例、电极脱位2例、胸壁肌肉跳动1例、起搏器介导心动过速1例，所有并发症发生率为1.8%，均经及时处理和有效护理后康复出院。结论 永久起搏器植入术是安全的，对起搏器植入术患者进行围手术期护理，及时发现和处理相关并发症，有利于患者的康复。
关键词： 永久起搏器植入术；围手术期护理；并发症
Abstract
Objective: To investigate the cause of cardiac pacemaker related perioperative complications and prevention strategies. Methods: 639 cases of patients with cardiac pacemaker implantation was enrolled and related perioperative complications, clinical curative and prevention effect of nursing strategy were analyzed. Results A total of 12 patients with perioperative complications complications, mainly for the sack hermorrhage in 6 patients, infection in 2 patients, electrode dislocation in 2 patients. After active treatment and effective nursing, all patients were discharged successfully. Conclusion : Pacemaker implantation is an effective measure to treat type slow arrhythmia, comprehensive perioperative nursing intervention can reduce the occurrence of complications, effective, discover in time and correct complications effectively, thus beneficial to patients recovery.
Key words： Cardiac Pacemaker Implantation; Related Complications; Nursing Care
参考文献 References
[1] 李玥，杨秀春，鲁静朝，等．心脏起搏器的历史进程及变迁. 临床荟萃. 2015，30( 8) : 841-843．
[2] Armaganijan LV, Toff WD, Nielsen JC, et al. Are elderly patients at increased risk of complications following pacemaker implantation? A meta-analysis of randomized trials. Pacing Clin Electrophysiol. 2012;35(2):131-134.
[3] Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2013, 61:e6-e75.
[4] Czunko A, Lelakowski J, Szczepkowski J. Usefulness of electrocardiographic and echocardiographic parameters for predicting the efficacy of atrioventricular synchronisation during a single lead VDD/R pacing. Kardiol Pol. 2009; 67(8A): 1019-1028.
[5] 何细飞，陶敏，周舸．不同卧床时间对心脏起搏器植入术后患者功能恢复的影响. 护理学杂志. 2006, 21(15):7-8.
[6] Miracapillo G, Costoli A,Addonisio L. Early activity after pacemaker implantation. J Cardiovasc med, 2016, (3) : 197-202.
[7] 江力勤, 钱钢, 刘加芳, 等．起搏器囊袋血肿的防治. 心脑血管病防治. 2006, 6(5): 329-330.
[8] 张丹花. 永久性心脏起搏器植入术并发症的护理进展. 上海护理. 2012，12 (1) : 67．
[9] Hildick-Smith DJ, Lowe MD, Newell SA, et al. Ventricular pacemaker upgrade: experience, complications and recommendations. Heart. 1998;79(4):383-387.
[10] 高曙光，卢飞舟. 永久心脏起搏器术后常见并发症发生原因及处理. 临床军医杂志. 2012, 6( 40) : 3．
[11] 王秋林，周鹏，蔡国才，等. 424例永久心脏起搏器治疗患者并发症回顾性分析. 成都医学院学报. 2011, 15( 4) : 235-236．
[12] 刘欣. 永久性心脏起搏器植入术后并发症的观察及护理. 护理实践与研究. 2012, 9( 7) : 46．
[13] Udo EO, Zuithoff NP, van Hemel NM, et al. Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm. 2012;9(5):728-735.
[14] Nery PB, Fernandes R, Nair GM, et al. Device-related infection among patients with pacemakers and implantable defibrillators: incidence, risk factors, and consequences. J Cardiovasc Electrophysiol. 2010;21(7):786-790.
[15] Bongiorni MG, Marinskis G, Lip GY, et al. How European centres diagnose, treat, and prevent CIED infections: results of an European Heart Rhythm Association survey. Europace. 2012;14(11):1666-1669.
[16] 张丹花．永久性心脏起搏器植入术并发症的护理进展. 上海护理. 2012，12 (1) : 67-70.
[17] 史扬，耿仁义．起搏器囊袋感染相关危险因素分析. 中华医院感染学杂志. 2010, 20( 6) : 797．
[18] Sohail MR, Uslan DZ, Khan AH, et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc. 2008;83(1):46-53
[19] 彭刚，舒茂琴，宋治远，等．起搏器囊袋并发症相关危险因素分析. 重庆医学. 2012, 4l(3):235.
[20] 李雅文. 起搏器囊袋感染的原因分析及预防护理现状. 天津护理. 2014, 22 (2): 2.
[21] 王俊岭，曹雪滨，张益，等. 永久性心脏起搏器置入术397 例并发症分析. 中国心血管病研究. 2012, 10( 3) : 211-212．
[22] 易文雅，杜红莉. 36例起搏器安装术后电极脱位的观察及护理. 现代临床护理. 2005, 4( 4) : 27-28.