目的 探討運用心臟臨時起搏器搶救嚴重心律失常、更換永久性心臟起搏器及心動過緩的外科手術患者圍手術期需用臨時起搏器保護的臨床效果及護理經驗。 方法 2008年8月－2011年7月，共對30例緩慢型心律失常者實施臨時心臟起搏術。術前做好患者的心理護理，做好器材及藥品準備；術中搶救器械、搶救藥品處于備用狀態，作好術中配合及病情觀察；術后護理，觀察生命體征及相關癥狀變化。 結果 安置心臟臨時起搏器患者共30例，除1例因合并下壁心肌梗死、嚴重心力衰竭搶救無效死亡外，其余均取得滿意的治療效果，術中、術后無并發癥發生，術后恢復良好，病情穩定出院。 結論 心臟臨時起博器運用于搶救嚴重心律失常患者、贏得進一步搶救時間，更換永久性心臟起博器患者的臨時保護，以及心動過緩的外科手術患者圍手術期保護，均是一種安全有效的治療方法。做好術前、術中及術后的護理是必要保證。Objective To investigate the clinical effects and nursing experiences of using temporary cardiac pacemaker in emergency rescue for patients with severe arrhythmia, in renewal of permanent cardiac pacemaker, or in peri-operative patients with bradycardia. Methods From August 2008 to July 2011, 30 patients with bradycardia arrhythmia underwent temporary cardiac pacemaker implantation surgery. We applied psychological nursing to the patients and made a good preparation of necessary equipments and medicine before operation. During the surgery, all required apparatuses and materials were ready at hand, and careful observation of conditions of the patients was carried out. After operation, the vital signs as well as the development of related symptoms in the patients were closely observed. Results There were 30 patients who had temporary cardiac pacemakers implanted. All got satisfying treatment effects except one who died from severe heart failure combined with inferior-wall myocardial infarction. No intraoperative or postoperative complications occurred, and the patients attained good postoperative recuperation before leaving hospital. Conclusion Temporary cardiac pacemaker is safe and effective in the emergency rescue of patients with severe arrhythmia, in temporary heart protection for patients undergoing renewal of permanent cardiac pacemaker, and in perioperative protection for patients with bradycardia. Good nursing before, during, and after the operation should be guaranteed.
【摘要】 目的 探討起搏器植入術后并發局部慢性潰瘍伴感染的綜合治療方法。 方法 2005年1月-2010年5月，收治4例心臟起搏器植入術后并發局部慢性潰瘍伴感染的患者。男3例，女1例；年齡3~79歲。心臟起搏器植入術后囊袋感染致皮膚破潰伴慢性潰瘍2例，起搏器植入后局部張力過高所致局部慢性潰瘍2例，其中2例患有2型糖尿病。所有患者均經過長期嚴格換藥保守治療3個月以上。手術徹底切除感染創面及相關包囊并盡可能剪除部分導絲，甚至更換導絲，根據情況原位或異位植入起搏器，并放置橡皮引流條，應用敏感抗生素5~7 d防治感染。術后2周拆線，主要觀察患者切口對合情況，是否存在紅腫、硬結、血腫、積液或化膿情況。 結果 4例患者術后均Ⅰ期愈合；4例均獲隨訪，隨訪時間7~11個月，平均9個月。原創面愈合好，無感染及潰瘍發生。 結論 通過外科手術綜合治療難治性心臟起搏器植入術后并發癥，能取得滿意療效。【Abstract】 Objective To explore comprehensive treatment options for local chronic ulcer with infection after the pacemaker implantation. Methods From January 2005 to May 2010, four patients (3 males and 1 female; 3-79 years old) with intractable ulcer with infection after pacemaker implantation were admitted. Pacemaker pocket infection induced chronic ulcer was in two, and tension induced chronic ulcers were in two. Two of the four patients were type II diabetes. All of the four patients underwent strict conservative treatment at least for 3 months prior to surgical treatment. Surgical treatment involved complete excision of infected tissue surrounding the pacemaker pocket and removal of all unnecessary lengths of pacemaker lead, even complete replacement of the original lead. Depending on the specific situation, pacemakers were either placed in their original position or a new position with a latex drainage strip. Patients then received a course of antibiotic treatment ranging from 5 to 7 days. Results All of the four patients achieved healing by first intention, and were followed up for 7-11 months, with an average of 9 months follow up. All patients achieved the satisfactory results. Conclusion A comprehensive treatment is effective on local chronic ulcer with infection after the pacemaker implantation.
