214例老年缓慢性心律失常植入心脏起搏器治疗的临床观察

Clinical observation of 214 cases with bradyarrhythmia in the elderly and pacemaker implantation

摘要:

目的 观察不同年龄段的老年患者在治疗缓慢性心律失常时植入心脏起搏器的临床特征。方法 选取2019年1月—2021年12月在内蒙古医科大学附属医院接受心脏永久起搏器植入治疗的214例缓慢性心律失常老年患者为研究对象，根据年龄不同分为60～69岁组（60例）、70～80岁组（82例）、> 80岁组（72例）。对比３组患者首发症状、起搏器植入病因、起搏器类型及随访电极参数。结果 所有入选者首发症状以黑蒙、晕厥为主（33.64%）。不同年龄组首发症状比较，差异无统计学意义（P >0.05）；老年女性乏力比例高于男性（P <0.05）。植入起搏器的病因依次为：病态窦房结综合征（以下简称病窦）79例（36.92%）、房室传导阻滞（AVB）78例（36.44%）、心房颤动（以下简称房颤）合并长间歇34例（15.89%）、双结病变23例（10.75%）。60～69岁组、70～80岁组病窦的占比均高于>80岁组（P <0.05），而>80岁组房颤合并长间歇占比高于其他两组（P <0.05）。老年女性病窦的占比高于男性，而男性Ⅱ度Ⅱ型AVB的占比高于女性（P <0.05）。起搏器植入类型以双腔为主体（185例，86.45%），>80岁组单腔起搏器植入数量高于70～80岁组（P <0.05）；术后7、90 d各组患者电极阈值和阻抗较术中均下降（P <0.05），术后7 d与术后90 d比较，差异无统计学意义（P >0.05）。各组患者相同时间点各个电极参数比较，差异无统计学意义（P >0.05）。结论 接受心脏永久起搏器治疗的缓慢性心律失常老年患者的临床特征具有年龄和性别差异。通过短期随访，不同年龄的老年患者右心室中低位间隔固定电极均安全有效。

Abstract:

Objective To observe the clinical characteristics of elderly patients with bradycardia undergoing cardiac pacemaker implantation in the treatment of chronic arrhythmias in different age groups.Methods A total of 214 elderly patients with chronic arrhythmias who underwent permanent pacemaker implantation at the Affiliated Hospital of Inner Mongolia Medical University from January 2019 to December 2021 were selected as the study subjects. According to different age groups, they were divided into the 60 to 69 years group (60 cases), 70 to 80 years group (82 cases), and > 80 years group (72 cases). The first symptoms, causes of pacemaker implantation, pacemaker types, and follow-up electrode parameters of patients in the three groups were observed and compared.Results The main initial symptoms of all selected patients were blurred vision and syncope (33.64%). There was no statistically significant difference in the comparison of initial symptoms among different age groups (P > 0.05). The proportion of fatigue in elderly women was higher than that in men (P < 0.05). The causes of pacemaker implantation were, in sequence: sick sinus syndrome in 79 cases (36.92%), atrioventricular block in 78 cases (36.44%), atrial fibrillation with long pauses in 34 cases (15.89%), and dual-node disease in 23 cases (10.75%). The proportion of sick sinus syndrome in the 60 to 69 years group and the 70 to 80 years group was higher than that in the > 80 years group (P < 0.05), while the proportion of atrial fibrillation with long pauses in the > 80 years group was higher than that in the other two groups (P < 0.05). The proportion of sick sinus syndrome in elderly women was higher than that in men, while the proportion of type II second-degree atrioventricular block in men was higher than that in women (P < 0.05). Dual-chamber pacemaker implantation was the main type (185 cases, 86.45%), and the number of single-chamber pacemaker implantations in the >80 years group was higher than that in the 70 to 80 years group (P < 0.05). The electrode thresholds and impedances of patients in each group decreased on postoperative days 7 and 90 compared to those during surgery (P < 0.05). There was no statistically significant difference in the comparison between postoperative days 7 and 90 (P > 0.05). There was no statistically significant difference in the comparison of various electrode parameters at the same time points among the groups (P > 0.05).Conclusion The clinical characteristics of elderly patients with bradycardia undergoing permanent cardiac pacemaker treatment exhibit age and gender differences. Through short-term follow-up, the right ventricular mid-to-low septal fixed electrode is safe and effective in elderly patients of different ages.