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題 名 | 心律調整器之置放對治療心臟傳導完全阻斷之三位病例報告=Implantation of Cardiac Pacemaker in the Treatment of Complete Heart Block with Report of Three Cases |
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作 者 | 張梅松; 俞瑞璋; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 2:3 民58.09 |
頁 次 | 頁129-135 |
關鍵詞 | |
語 文 | 中文(Chinese) |
中文摘要 | 1.心臟傳導阻斷引起的因素甚多,除手術後所導致外,大多數均以冠狀血管心臟疾病所致。所以國人羈此疾者不多,但是於最近一年內本院曾有三位患者,接受心律調整器之置放治療,結果良好。 2.心律調整器為治療心臟傳導阻斷之最有效的一種方法。對於安置之適應症,選擇何種類型的心律調整器以及選擇何種途徑放置電極及手術後合併症等均簡加討論。 |
英文摘要 | The patient with complete heart clock lives constantly with the threat of sudden cessation of an effective circulation. Since Chardack et al developed an implantable cardiac pacemaker and reported their first experience in human work in 1960, this condition can now be successfully managed through the use of electricl cardiac pacemaking. Implantation of cardiac pemaker is generally indicated in patients with the following conditions: 1) slow ido-ventricular rate below 40 per minute without significant response to drug therapy, 2) repeated attacks of Stokes-Adams syndrome, 3) instabili ty of ventricular rhythm and 4) evidence of congestive heart filure. Implantable pacemakers are of four general types. The most common one has a fixcd rate which is independent of either the spontaneous atrial or ventricular rate. The pacemaker fires at a preset rate. A second type responds to atrial rate and rhythm, and is known as synchronous pacemaker. The third type is the stand-by or demand unit. It detects the ventricular R wave and does not stimulate until a preset time interval has passed. The last one is the induction or radiofrequency pacemaker which works through the transmission of power across the intact skin from an extcrnal generator to an implanted receiving coil. The selection of types of pacemaker to be used generally depends upon the age and ability of the patient as well as duration and character of the arrhythmia. The recent trend favors toward the use of stand-by or demand unit, especially in patients with intermittent heart block. Electrodes may be attached to the heart in two ways, by direct suture to the myocardium or by the transvenous route from a peripheral vein. Direct attachment of the electrode to the heart requires a thoracotomy whereas the transvenous approach can he carried out uder local anesthesia. Therefore, the latter is especially suitable for the elderly or poor risk patients. The major complications from the implantation of pacemaker include wire breaksge, electrode dislodgement, infection, perforation of the ventricle, competition and generator failure. These diffculties have been greatly reduced through better electrode design, improved technique in implantation and proper selection of pacer in individual case. After a pacemaker has been installed, the clinical attention must swing over from the disease of the patient to frailties of the pacemaker. The pacemaker should be replaced with a new one when the batteries in the unit become exhausted, usually in two to three years. Elective replacement can usually be made with the cooperaiton of the patient. Three patients with complete heart heart block, treated with implantation of cardiac peemaker at the Veterans General Hospital in recent one year, were reported in this commuication. Cordis fixed-rate pacemaker with myocardial electrode was employed in the first patient who had had repeated attacks of Stokes-Adams syndrome despite of drug therapy. Her postoperative course was satisfactory. Demand pacers (AO and Cordis) with endocardial electrodes by transvenous route were used in other two patients. Their relatively young age or intermittent heart block is the reason of choosing demand type in these two patients. Infection of the pacer pocket due to staphylococcus aureus complicated the postoperative course in the second case. Daily aspiration followed by local instillation of Lincocin in addition to systemic antibiotics controlled the infection in one week, and the pacemaker has remained in good function. Dislodgement of the endocardial electrode with subsequent failure to pace occurred on the seventh postoperative day in the third patient. Successful cardiac pacing was restored after the electrode was manipulated on the following day. |
本系統中英文摘要資訊取自各篇刊載內容。