目的 分析和总结心律植入装置植入术后慢性心脏电极穿孔的的识别以及处理策略.方法 对 2007 年1 月至 2019 年 1 月于北京大学人民医院诊断慢性心脏电极穿孔并且成功拔除穿孔电极患者的临床资料进行回顾性分析,分析患者临床症状、血流动力学情况、电极拔除情况及并发症等.结果 共入选 30 例,其中胸痛 15 例(50.0%),呼吸困难 4 例(13.3%),肌肉刺激 3 例(10.0%),意识丧失 3 例(10.0%),无症状者 5 例(16.7%);合并心包积液 2 例(6.7%),伴有周围器官损伤 1 例(3.3%).30 例术前血流动力学均稳定,收缩压(131.5±15.1)mmHg,舒张压(77.0±9.7)mmHg.经静脉拔除 19 例(63.3%),经开胸手术成功拔除穿孔电极 11 例(36.7%).经静脉拔除患者中,直接拔除 3 例(10.0%),经锁定钢丝拔除 12 例(43.3%),经 Snare 下腔回收装置拔除 2 例(6.7%),经激光鞘拔除 1 例(3.3%),术前行心包穿刺并留置猪尾导管 4 例(13.3%).1 例(3.3%)患者经开胸手术拔除穿孔电极术后出现手术切口感染,予抗感染、伤口换药后愈合良好.结论 对于血流动力学稳定的慢性心脏电极穿孔,经静脉和手术拔除穿孔电极是有效、安全的处理策略.
Objective To analyze and summarize the identification and treatment strategy of chronic cardiac perfo-ration caused by pacing lead.Methed Retrospectively analyzed the clinical data of patients who were diagnosed with chronic cardiac perforation caused by pacing lead and underwent transvenous lead extraction(TLE)procedure in Peking University People's Hospital from January 2007 to January 2019.Result The perforating leads of 30 patients with chronic cardiac perforation were successfully removed,including 15(50.0%)patients with chest pain,4(13.3%)patients with dyspnea,3(10.0%)patients with muscle irritation,3(10.0%)patients with loss of con-sciousness,5(16.7%)patients with no symptoms;2(6.7%)patients with pericardial effusion,and 1(3.3%)patient with peripheral organ injury.The hemodynamics of 30 patients were stable before procedure,with systolic blood pressure of(131.5±15.1)mmHg and diastolic blood pressure of(77.0±9.7)mmHg.The perforating leads were successfully removed in 19(63.3%)patients by TLE,and in 11(36.7%)patients via thoracotomy.Among the pa-tients undergoing TLE,3(10.0%)patients were directly removed,12(43.3%)patients were removed by locking stylet,2(6.7%)patients were removed by Needle's Eye Snare,1(3.3%)patients was removed by laser sheath,and 4(13.3%)patients underwent pericardiocentesis before procedure.Incision infection occurred in 1(3.3%)patient af-ter thoracotomy,and the wound healed well after anti-infection and dressing change.Conclusion For patients with chronic cardiac perforation who are hemodynamically stable,TLE and via thoracotoray can be safe and effective treatment strategy.