Insertion of permanent pacemakers as a day case procedure: Authors' reply
Insertion of permanent pacemakers as a day case procedure: Authors' reply
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插入永久起搏器作为日间手术：作者的回复
DOI：
10.1136/bmj.300.6717.119-a
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发表时间：
1990
影响因子：
--
通讯作者：
D. Ward
中科院分区：
文献类型：
--
作者：
G. Haywood;A. Camm;D. Ward
先生，-Guy A Haywood博士及其同事报告说，作为日间病例程序插入永久性起搏器与传统入院一样为患者所接受，并且这些组的并发症发生率相当。我想提请他们注意几个事实。据报告，日间病例组中导致夺获失败的电极导线移位发生率为1/21，常规治疗患者中为1/19。作者未提及这是在住院期间还是出院后发现的，以及表现方式。由于只有37例患者植入了新的永久性起搏器（3例仅植入了发生器），电极导线脱位后夺获失败的发生率为2/37-即超过5%。尽管两组之间没有显著差异，但考虑到目前的电极导线设计，这是一个显著较高的位移率。据报告，发生率低至04%，2并且在我最近的73例患者中未发生该问题。这是一个极其重要的并发症：对于依赖起搏器的患者，夺获失败可能是致命的，特别是如果患者已经出院。因此，我是否可以建议作者在日常病例基础上植入永久性起搏器之前，审查并在必要时修改其电极导线植入方法？此外，作者还提到，艾德使用了”标准植入手术”，但没有说明通过锁骨下穿刺或头静脉切开进行的手术的确切数量。值得注意的是锁骨下穿刺形成血肿的可能性很大。3在头静脉切断中完全止血是可能的，因为同样的操作是在视觉下进行的。因此，在接受永久性起搏器植入的患者中，作为日间手术，头静脉切断将是首选，以防止血肿形成和随后感染的并发症。
SIR,-Dr Guy A Haywood and colleagues report that the insertion of permanent pacemakers as a day case procedure is as acceptable to patients as conventional admission and that the incidence of complications is comparable in these groups. I wish to draw their attention to a few facts. The incidence of lead displacement causing capture failure was reported to be 1/21 in the day case group and 1/19 among patients managed conventionally. Whether this was detected during the hospital stay or afterdischarge and the mode of presentation have not been mentioned by the authors. As only 37 patients received new permanent pacemakers (three having received only generators), the incidence of capture failure fol-lowing lead dislodgement is 2/37-that is, more than 5%. Although there was no significant difference between the two groups, this is a significantly high rate of displacement considering the present lead designs. The rate has been reported to be as low as 04%, 2 and this problem has not occurred in my latest 73 patients. This is an extremely important complication: for patients who depend on pacemakers capture failure could be fatal, especially if the patient has been discharged from the hospital. May I therefore suggest that the authors review and if necessary revise their method of lead implantation before taking to implanting permanent pacemakers on a day case basis? Also, the authors have mention, ed that" standard implantation procedures" were used but did not specify the exact number of procedures performed by subclavian puncture or cephalic vein cut down. It is important to note that the chances of haematoma formation are considerable with subclavian puncture. 3 In cephalic venous cut down complete haemostasis is possible because the same is done under vision. Thus in patients undergoing permanent pacemaker implantation as a day case procedure cephalic venous cut down would be preferable to prevent the complication of haematoma formation and subsequent infection.