【摘要】 目的 探讨起搏器植入术后并发局部慢性溃疡伴感染的综合治疗方法。 方法 2005年1月-2010年5月，收治4例心脏起搏器植入术后并发局部慢性溃疡伴感染的患者。男3例，女1例；年龄3~79岁。心脏起搏器植入术后囊袋感染致皮肤破溃伴慢性溃疡2例，起搏器植入后局部张力过高所致局部慢性溃疡2例，其中2例患有2型糖尿病。所有患者均经过长期严格换药保守治疗3个月以上。手术彻底切除感染创面及相关包囊并尽可能剪除部分导丝，甚至更换导丝，根据情况原位或异位植入起搏器，并放置橡皮引流条，应用敏感抗生素5~7 d防治感染。术后2周拆线，主要观察患者切口对合情况，是否存在红肿、硬结、血肿、积液或化脓情况。 结果 4例患者术后均Ⅰ期愈合；4例均获随访，随访时间7~11个月，平均9个月。原创面愈合好，无感染及溃疡发生。 结论 通过外科手术综合治疗难治性心脏起搏器植入术后并发症，能取得满意疗效。【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.
In order to improve the reliability of cardiac pacemaker contact-less power supply technology, this paper proposes a novel application of wireless feedback voltage stabilizing technology to adjust heart disease patients with inner power supply filter circuit output voltage and current control method, to keep the output voltage stability, and to ensure that the super capacitor and cardiac pacemaker to get a stable power supply. To implement the real-time accurate voltage control with considering the primary and secondary side inductance coupling coefficient changes, the change of the external power supply voltage and load, it is necessary to test thee real-time and accurate output voltage and current value after rectifying filtering. Therefore, based on the chaotic control theory, we adopted method of phase diagram on the basis of the quick observation after rectifying filtering, so that the method of voltage and current could improve the detection time of the circuit. The phase diagram of proposed control method can be divided into 8 segments, and we got 7 zero-extreme points. When these zero-extreme points are detected, according to extreme points of the zero instantaneous values, the corresponding average values of voltage and current were obtained. Simulation and experimental results showed that using the above method can shorten the response time to less than switch devices 1/2 switching cycles, thus validating the effectiveness and feasibility of the proposed detection algorithm.
ObjectiveTo analyze the impact of balloon post-dilation on cardiac conduction in patients undergoing transcatheter aortic valve replacement (TAVR). MethodsFrom June 2021 to December 2022, patients with severe aortic valve stenosis or regurgitation who underwent TAVR surgery using domestically produced valves at Xijing Hospital, Air Force Military Medical University were selected. The occurrence of intraoperative and postoperative cardiac conduction block was recorded. According to whether balloon post-dilation was performed during the surgery, patients were divided into the post-dilation group and the non-post-dilation group. The baseline data, postoperative cardiac conduction block occurrence, and cardiac function of the two groups were analyzed. ResultsA total of 126 patients were included, including 83 males and 43 females, with an average age of 66.6±7.6 years. There were 30 patients in the post-dilation group and 96 patients in the non-post-dilation group. On the first day after TAVR, the average QRS intervals in the post-dilation group and the non-post-dilation group were 105.6±13.8 ms and 125.9±28.2 ms, respectively (P=0.017). At discharge, the average PR intervals in the two groups were 168.7±36.8 ms and 192.1±44.2 ms, respectively (P=0.024). After TAVR, 9 (7.1%) patients developed new atrioventricular block, 5 (4.0%) patients developed complete right bundle branch block, and 33 (26.2%) patients developed complete left bundle branch block. During hospitalization, 2 (1.6%) patients received permanent cardiac pacemakers, both of whom were in the non-post-dilation group. There was no statistical difference in postoperative left ventricular structure and function between the two groups (P>0.05). ConclusionPostoperative expansion using domestically produced interventional valves for TAVR do not increase the incidence of early atrioventricular block and permanent cardiac pacemaker implantation after valve implantation, and there are no significant changes in cardiac structure and function in patients with conduction block in the short term after surgery.