护理器:为患者选择合适的设备
Sana M Al-Khatib1, Paul Friedman2, Kenneth A Ellenbogen2
1From the Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.). alkha001@mc.duke.edu.
Circulation
|November 2, 2016
概括
临床医生必须了解可植入心脏变压器 (ICD),皮下心脏变压器 (S-ICD) 和可穿戴设备,以获得最佳的患者结果. 需要进一步的研究来完善选择标准,并比较设备的疗效.
科学领域:
- 心脏病学
- 生物医学工程
- 医疗器械
背景情况:
- 在除技术的进步提供了各种设备的选择:透静脉植入式心电除器 (ICD),皮下心电除器 (S-ICD) 和可穿戴心电除器.
- 通过静脉注射的ICD可以改善心室动或心跳动的患者的存活率,但对于特定的患者子组和选择标准仍然存在知识差距.
- 皮下药物具有较低的感染和并发症风险,但缺乏胸肌/心脏阻塞,因此需要进一步的疗效和最佳使用数据.
研究的目的:
- 审查当前的除设备技术,包括静脉输入式心脏除器,S-ICD和心脏再同步治疗除器.
- 要突出与每个设备类型相关的临床应用,优势,局限性和知识差距.
- 为临床医生提供关于患者选择和最佳使用这些救命设备的信息.
主要方法:
- 对静脉输入性ICD,S-ICD和心脏再同步治疗除器的现有临床试验和文献的审查.
- 分析患者的特征,产品的适用情况和有效性.
- 确定目前的知识缺口和未来研究领域.
主要成果:
- 经过静脉注射的ICD已被证明可以改善心力衰竭和心律失常的特定患者群体的生存率.
- 对于感染风险较高或血管通道有限的患者来说,S-ICD是一种可行的替代方案,尽管存在节奏限制.
- 心脏再同步疗法-除器可以改善心力衰竭患者的生存率和生活质量,但显著的无反应率仍然是一个挑战.
结论:
- 为了最大限度地发挥除疗法的益处,最好选择患者并了解设备特征至关重要.
- 进一步的研究对于解决知识缺口,完善选择标准和改善所有类型的除器件的结果至关重要.
- 设备技术和患者管理策略的持续进步旨在提高除治疗的有效性,以预防心脏突然死亡.
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