中高龄老年患者心律植入装置迟发感染经静脉拔除电极导线的临床经验

武梦威; 胡一东; 杨柳; 胡凯; 苏浩

doi:10.16766/j.cnki.issn.1674-4152.003066

中高龄老年患者心律植入装置迟发感染经静脉拔除电极导线的临床经验

doi: 10.16766/j.cnki.issn.1674-4152.003066

武梦威^{1, 2},
胡一东^{1, 2},
杨柳^{2, 3},
胡凯²,
苏浩^2, ,

1.
皖南医学院研究生学院，安徽芜湖 241000
2.
中国科学技术大学附属第一医院(安徽省立医院)心血管内科，安徽合肥 230002
2.
蚌埠医学院研究生学院2021级研究生，安徽蚌埠 233030

基金项目:

安徽省学术和技术带头人后备人选科研活动经费资助项目 2018H176

安徽省心血管病研究所2018年度第二批科研项目 KF2018005

详细信息

通讯作者:
苏浩，E-mail：suhaod@126.com

中图分类号: R318.11 R541.7
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出版历程
- 收稿日期: 2022-03-04
- 网络出版日期: 2023-08-28

Clinical experience of intravenous removal of lead electrodes in middle-aged and elderly patients with delayed infection of cardiac implantable electronic device

WU Mengwei^{1, 2},
HU Yidong^{1, 2},
YANG Liu^{2, 3},
HU Kai²,
SU Hao^{2
, ,}

1.
Graduate School of Wannan Medical College, Wuhu, Anhui 241000, China

摘要

摘要: 目的回顾分析中高龄老年患者心律植入装置迟发感染经静脉拔除电极的安全性和可行性。方法收集2015年5月—2021年5月就诊于中国科学技术大学附属第一医院(安徽省立医院)因起搏器装置术后迟发感染住院经静脉拔除电极的60例患者。依据年龄分为年轻组(< 70岁)32例、中高龄组(≥70岁)28例，收集患者基线数据、手术资料及术后并发症情况，分析2组患者经静脉拔除电极的有效性及安全性。结果入选的60例患者中，中高龄组年龄为(77.5±4.7)岁，男性患者18例(64.3%, 18/28)；年轻组患者年龄为(57.1±8.7)岁，男性患者23例(71.9%，23/32)。2组患者合并症如心房颤动[9.4%(3/32) vs. 35.7%(10/28)]、高血压[3.1% (1/32) vs. 53.6% (15/28)]、冠心病[3.1% (1/32) vs. 25.0% (7/28)]比较差异有统计学意义(均P<0.05)。2组患者并发症发生率[3.1%(1/32) vs. 7.1%(2/28)，P=0.476]及完全手术成功率[96.9%(31/32) vs. 96.4%(27/28)，P=0.923]比较差异无统计学意义。结论心律植入装置迟发感染经静脉拔除电极在中高龄老年患者中是安全的、可行的。
- 中高龄 /
- 心律植入装置 /
- 迟发感染 /
- 经静脉电极拔除术
Abstract: Objective To retrospectively analyze the safety and feasibility of transvenous lead extraction (TLE) in middle-aged and elderly with delayed infection of cardiac implantable electronic device (CIED). Methods A total of 60 TLE patients with delayed infection of CIED hospitalized at the First Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from May 2015 to May 2021 were collected. The patients were divided into the younger group (< 70 years old, n=32) and the middle-aged and elderly group (≥70 years old, n=28) according to the age. The baseline data, surgical data and postoperative complications of the patients were collected to analyze the efficacy and safety of transvenous electrode removal in the two groups. Results Among the 60 patients enrolled, the age of the middle-aged and elderly group was (77.5±4.7) years old with 18 male patients (64.3%, 18/28), the age of the younger group was (57.1±8.7) years old with 23 male patients (71.9%, 23/32). The differences of two groups on complications for patients such as atrial fibrillation [9.4% (3/32) vs. 35.7% (10/28)], hypertension [3.1% (1/32) vs. 53.6% (15/28)], coronary heart disease [3.1% (1/32) vs. 25.0% (7/28)] were statistically significant (all P<0.05). There was no significant difference in complication rate [3.1% (1/32) vs. 7.1% (2/28), P=0.476] and complete surgical success rate [96.9% (31/32) vs. 96.4% (27/28), P=0.923] between the two groups. Conclusion The safety and feasibility of TLE in middle-aged and elderly patients with delayed infection of CIED is safe and feasible.
- Middle-aged and elderly /
- Cardiac implantable electronic device /
- Delayed infection /
- Transvenous lead extraction

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表 1 2组迟发感染患者基线资料比较

Table 1. Comparison of baseline data between the two groups of patients with delayed infection

组别	例数	性别(例)		年龄(x±s，岁)	LVEF(x±s，%)	LVEDD(x±s，mm)	LAD(x±s，mm)	既往病史[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	LVEF(x±s，%)	LVEDD(x±s，mm)	LAD(x±s，mm)	心房颤动	冠心病	高血压	糖尿病	脑梗死
年轻组	32	23	9	57.1±8.7	46.2±18.5	64.3±13.8	45.3±7.2	3(9.4)	1(3.1)	1(3.1)	5(15.6)	0
中高龄组	28	18	10	77.5±4.7	56.6±11.2	56.6±11.2	42.4±6.8	10(35.7)	7(25.0)	15(53.6)	5(17.9)	3(10.7)
统计量		0.866^a		11.106^b	2.566^b	2.595^b	1.957^b	6.104^a	6.184^a	19.433^a	0.054^a	3.609^a
P值		0.366		< 0.001	0.013	0.012	0.055	0.013	0.013	< 0.001	0.817	0.057
注：^a为χ²值，^b为t值。

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表 2 2组迟发感染患者手术特征比较

Table 2. Comparison of surgical characteristics between the two groups of patients with delayed infection

组别	例数	起搏器植入适应证[例(%)]						起搏器类型[例(%)]
组别	例数	扩张型心肌病	房室传导阻滞	病窦综合征	心房颤动伴长间歇	其他		DDD	VVI	CRT	ICD
年轻组	32	14(43.8)	7(21.9)	8(25.0)	2(6.3)	1(3.1)		14(43.8)	2(6.3)	14(43.8)	2(6.3)
中高龄组	28	6(21.4)	8(28.6)	10(35.7)	3(10.7)	1(3.6)		17(60.7)	4(14.3)	6(21.4)	1(3.6)
统计量		3.348^a	0.357^a	0.816^a	0.390^a	0.009^a		1.721^a	1.071^a	3.348^a	0.226^a
P值		0.067	0.550	0.366	0.533	0.923		0.190	0.301	0.067	0.635

组别	例数	植入年限[M(P₂₅, P₇₅)，年]	拔除电极方式[例(%)]			拔除电极数目[根(%)]		部分拔除[根(%)]	手术完全成功[例(%)]	对侧植入新装置[例(%)]
组别	例数	植入年限[M(P₂₅, P₇₅)，年]	徒手	借助工具		主动电极	被动电极	部分拔除[根(%)]	手术完全成功[例(%)]	对侧植入新装置[例(%)]
年轻组	32	4.0(2.0, 7.0)	6(18.8)	26(81.2)		13(16.7)	65(83.3)	2(2.6)	31(96.9)	15(46.9)
中高龄组	28	4.0(2.0, 7.0)	7(25.0)	21(75.0)		9(15.3)	50(84.7)	1(1.7)	27(96.4)	9(32.1)
统计量		1.495^b	0.344^a	1.163^a		0.291^a	3.506^a	2.018^a	0.009^a	1.350^a
P值		0.226	0.558	0.559		0.864	0.447	0.365	0.923	0.245
注：^a为χ²值，^b为Z值。DDD为双腔起搏器(dual-chamber DDD pacemakers)；VVI为单腔起搏器(ventricular demand inhibited pacemaker)；CRT为心脏再同步化治疗(cardiac resynchronization therapy)；ICD为埋藏式心律转复除颤器(implantable cardioverter-defibrillator)。

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表 3 2组迟发感染患者围手术期情况及术后并发症比较

Table 3. Comparison of perioperative conditions and postoperative complications between the two groups of patients with delayed infection

组别	例数	住院时间[M(P₂₅, P₇₅)，d]	抗生素使用时间(x±s，d)	术后发热[例(%)]	主要并发症[例(%)]	次要并发症[例(%)]
年轻组	32	21.0(15.0, 31.5)	14.4±7.7	4(12.5)	0	1(3.1)
中高龄组	28	21.0(15.0, 32.0)	13.3±5.1	3(10.7)	0	2(7.1)
统计量		1.298^a	0.616^b	0.046^c		0.508^c
P值		0.259	0.540	0.830		0.476
注：^a为Z值，^b为t值，^c为χ²值。

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