目的:头静脉切开(CVC)和锁骨下穿刺(SP)是起搏器植入的最常见途径。这项研究的目的是比较这些方法的围/术后并发症。
方法:对北莱茵-威斯特法伦州的质量保证数据进行回顾性分析,以根据静脉通路评估首次起搏器植入的围/术后并发症。主要终点定义为以下之一的发生:心搏停止,心室纤颤,气胸,血胸,心包积液,口袋血肿,铅位错,铅功能障碍,术后伤口感染或其他需要干预的并发症。描述性分析是通过绝对的,相对频率和赔率比。Fisher精确检验用于比较两个研究组。
结果:从2010年至2014年的139,176例起搏器植入,由于其他/双重接入而排除了15,483例。中位年龄为78岁,使用的访问方法为CVC75,251例(60.8%),SP48,442例(39.2%)。植入装置主要为双腔起搏器(CVC组为73.9%,SP组为78.4%)。其次是单腔起搏器VVI(CVC组和SP组分别为24.9%和19.9%)。与SP组相比,CVC组围/术后并发症明显少(2.49%vs.3.64%,p=0.0001,OR1.47;95%CI1.38-1.57)。
结论:CVC作为起搏器植入的静脉通路,其围/术后并发症明显少于SP,似乎是一种有利的技术。
OBJECTIVE: The cephalic vein cutdown (CVC) and the subclavian puncture (SP) is the most common access for pacemaker implantation. The purpose of this study was to compare the peri-/postoperative complications of these approaches.
METHODS: A retrospective analysis of the quality assurance data of the state of North Rhine-Westphalia was performed to evaluate the peri-/postoperative complications of first pacemaker implantation according to the venous access. The primary endpoint was defined as the occurrence of one of the following: asystole, ventricular fibrillation, pneumothorax, hemothorax, pericardial effusion, pocket hematoma, lead dislocation, lead dysfunction, postoperative wound infection or other complication requiring intervention. Descriptive analysis was done via absolute, relative frequencies and Odds Ratio. Fisher\'s exact test was used for comparison of the both study groups.
RESULTS: From 139,176 pacemaker implantations from 2010 to 2014, 15,483 cases were excluded due to other/double access. The median age was 78 years and the access used was CVC for 75,251 cases (60.8%) and SP for 48,442 cases (39.2%). The implanted devices were mainly dual-chamber pacemakers (73.9% in the CVC group and 78.4% in the SP group), followed by single-chamber pacemakers VVI (24.9% and 19.9% in the CVC and SP group respectively). There were significantly fewer peri/postoperative complications in the CVC group compared to the SP group (2.49% vs. 3.64%, p = 0.0001, OR 1.47; 95% CI 1.38-1.57).
CONCLUSIONS: CVC as venous access for pacemaker implantation has significantly fewer peri/postoperative complications than SP and appears to be an advantageous technique.