目的 探讨运用心脏临时起搏器抢救严重心律失常、更换永久性心脏起搏器及心动过缓的外科手术患者围手术期需用临时起搏器保护的临床效果及护理经验。 方法 2008年8月－2011年7月，共对30例缓慢型心律失常者实施临时心脏起搏术。术前做好患者的心理护理，做好器材及药品准备；术中抢救器械、抢救药品处于备用状态，作好术中配合及病情观察；术后护理，观察生命体征及相关症状变化。 结果 安置心脏临时起搏器患者共30例，除1例因合并下壁心肌梗死、严重心力衰竭抢救无效死亡外，其余均取得满意的治疗效果，术中、术后无并发症发生，术后恢复良好，病情稳定出院。 结论 心脏临时起博器运用于抢救严重心律失常患者、赢得进一步抢救时间，更换永久性心脏起博器患者的临时保护，以及心动过缓的外科手术患者围手术期保护，均是一种安全有效的治疗方法。做好术前、术中及术后的护理是必要保证。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.
Objective To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker （PPM） implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker （AAI） PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis （IE） in 5 patients, tricuspid insufficiency （TI） in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty （TVP）， tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively， all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient after TVP had mild TI during follow-up. Conclusion Surgical treatment should be performed as early as possible when infection is too severeto control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.
Objective To construct the expression short hairpin RNA （shRNA） targeting gene kir2. 1 in rat myocardial cells, named pEGFP6 kir2. 1, and to observe the effects on the expression of messenger RNA（mRNA） and protein of gene kir2. 1 as well as the changes of myocardial beating rates. Methods Five RNA interference （RNAi） sites targeting the rat kir2. 1 gene was selected, designed and synthesized five pairs of oligonucleotides fragments ,annealed them to double-strand, then cloned them into the vectors containing U6 promoter,obtained the vector expressing five aim genes. Rat myocardial cells were divided into three groups： Experimental group, negative plasmid control group and normal control group. Reverse transcription-polymerase chain reaction（RT PCR） and Western-blot were carried out to detect the expression of the mRNA and protein of gene kir2.1 and the beating rates of myocardial cells were observed after 72 h. Results The expression of mRNA and protein of gene kir2. 1 of experimental group were markedly lower than that of other two control groups after 72 h（P〈0.01）. There was no statistically significant between two control groups. The beating rate in experimental group was much faster than other two control groups （P〈0.01）, remained unchanged in both negative plasmid control group and normal control group. Conclusion Plasmid pEGFP6-kir2.1 could suppress the expression of the mRNA and protein of kir2.1 and increase the rat cardiac muscle cell beats.
Objective To review the current status and problems in developing cardiac biological pacemaker(CBP) by cell transplantation. Methods The l iterature over the past decade concerning CBP constructed through celltransplantation was reviewed and summarized. Results Experiments in vivo testified that the cell transplantation was feasible for CBP construction, and the transplantation of sinus atrial node cell and stem cell was still the predominant method for constructing CBP. However, such problems as difficult ampl ification of transferred cardio muscle cell, low success rate of CBP construction as well as unstable function of CBP make it lag behind the tremendous cl inical demands. The gene transfection technology might be one of the approaches to resolve these issues. Conclusion As one feasible method for CBP construction, the cell transplantation has a bright future in the cl inical appl ication and is worthy of further study.
【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.
目的 调查安置永久性人工心脏起搏器的老年患者术前焦虑状况，为制订护理对策提供依据。 方法 2004年7月-2008年7月收治需安置永久性人工心脏起搏器的心脏病患者78例，术前采用焦虑自评量表（SAS）对其进行问卷调查，并采用自制一般情况问卷调查了解情况。 结果 植入永久性心脏起搏器的老年患者术前SAS得分高于国内常模（Plt;0.05）。根据自制调查问卷结果，差异有统计学意义（Plt;0.05）的项目:老年患者随年龄增长焦虑量表评分降低；丧偶者焦虑评分高于有配偶者；完全公费、部分公费、自费的焦虑量表评分依次增高；老年患者对起搏器知识了解程度越少，焦虑评分越高；无家人陪伴者比有家人陪伴者焦虑评分高。而性别、文化水平差异无统计学意义。 结论 植入永久性起搏器的老年患者术前多数存在焦虑情绪，且焦虑与年龄、婚姻、费用支付方式、有无家人陪伴、相关知识等有一定关系，医护人员应针对性地做好患者术前护理，帮助患者面对现实，以积极的心态接受手术治疗。
ObjectiveTo explore the efficacy of an innovative approach of follow-up in patients implanted with permanent pacemaker (DDD). MethodsA total of 400 patients who underwent permanent pacemaker (DDD) implantation between June 2011 and June 2013 were included in the present study. Patients were randomly assigned to the innovative and conventional follow-up groups in a 1：1 manner (200 patients in each group). The baseline characteristics were well balanced with no statistically significant differences in the mean age, proportion of male sex, prevalence of hypertension, position of the electrode or the device used between the two groups. At the end of the follow-up, patient outcomes were compared between the two groups. ResultsThe outcomes of patients were better in the innovative follow-up group, with higher degree of satisfaction, better state of health, lower incidence of complications, and less frequent readmission and follow-up visits (all P<0.05). ConclusionThe innovative approach of follow-up considerably improves patient outcomes, and can be useful in future clinical practice.
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.