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超高龄患者永久心脏起搏治疗的临床观察

Clinical observation of permanent pacemaker implantation in extremely elderly patients

    摘要
  • 摘要:
      目的  探讨超高龄(90岁以上)患者永久心脏起搏治疗的一般临床特性、疗效及安全性。
      方法  回顾性分析21例超高龄行永久心脏起搏治疗患者的临床资料，包括年龄、性别、适应证、合并疾病、认知能力评估、手术并发症及手术前后心、肾功能指标变化等，并观察术后1年的临床随访结果。
      结果  所有患者顺利完成手术，术后心动过缓所致症状消失; 1例发生起搏器介导心动过速，经程控参数后终止; 1例术后心衰加重，经药物治疗后好转出院，于术后10个月死于肺部感染; 1例于术后11个月死于颅内恶性肿瘤; 本组患者无其他手术相关并发症发生，术后12个月左室射血分数(LVEF)及肾功能较术前无显著变化。
      结论  超高龄患者行永久心脏起搏治疗有效而安全，术后1年内肾功能、LVEF等较术前无明显变化。

     

    Abstract:
      Objective  To evaluate the general clinical features, clinical outcomes, and safety of permanent pacemaker implantation for extremely elderly patients over 90 years old.
      Methods  Clinical data of 21 patients, including age, sex, indications of the operation, comorbidities, assessment of cognitive abilities, complications, changes of preoperative and postoperative renal and cardiac functions. Follow-up results after1 year of surgery were observed.
      Results  All cases succeeded in pacemaker implanting, and symptoms of bradycardia disappeared after surgery. Of these patients, 1 case occurred bradycardia caused by pacemaker implantation, and ceased after programmable adjustment of pacemaker parameters; 1 had worsened postoperative heart failure, and was discharged after medical treatment, but died of lung infection after 10 months of operation; 1 case died of malignant brain tumor after 11 month of operation. No other complications were observed during the operation, and no significant changes in renal function and left ventricular ejection fraction (LVEF) were found at 12 month after the operation compared with preoperation.
      Conclusion  Permanent pacemaker implantation is effective and safe in extremely elderly patients. No significant changes in renal function and LVEF at 12 month after operation were seen compared with preoperation.

     

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