从技术陷到临床后果:无节奏作为救援解决方案
Fulvio Cacciapuoti1, Ciro Mauro1, Flavia Casolaro2
1Division of Cardiology, "A. Cardarelli" Hospital, 80131 Naples, Italy.
Reports (MDPI)
|October 24, 2025
概括
早期的起器失效可能会导致中风. 无节奏为涉及静脉封闭和抗凝的复杂病例提供了安全的解决方案,确保设备功能和患者康复.
科学领域:
- 心脏病学 心脏病学
- 医疗器械技术 医疗器械技术
- 神经学 神经学
背景情况:
- 双室心脏起器的早期衰竭不常见,但严重,可能导致诸如中风等血栓栓塞事件.
- 技术植入问题,例如不当的固定,可能会导致过早的损坏和设备故障.
- 这个案例强调了诊断中风,管理重新植入的挑战,以及无节奏的实用性.
研究的目的:
- 介绍一例导致中风的双腔心脏起器失效的情况.
- 为了说明复植在静脉封闭患者和抗凝药的挑战.
- 为了证明无节奏作为复杂情景中的救援策略的有效性.
主要方法:
- 一名78岁的男性患有完全心房阻塞,在双室心脏起器植入后一年经历了中风症状.
- 设备询问显示了绝缘故障和电池耗尽;成像显示了缩和左下关节静脉封闭.
- 通过大腿部接入植入一个无心脏起器,并使用数字-8 suture技术实现静血.
主要成果:
- 患者出现了急性中风 (失语,半衰) 和新发动的心房动.
- 由于静脉封闭和提取风险很高,传统的透静脉再植入是不可行的;抗凝剂排除了右侧再植入.
- 成功的无心脏起器植入导致稳定的设备功能和有利的神经恢复 (mRS=2) 两个月后.
结论:
- 复杂的患者场景,包括中风,心律失常,器械故障,静脉封闭和抗凝药,需要创新的解决方案.
- 在这种具有挑战性的临床情况下,无节奏被证明是安全有效的救援策略.
- 这一案例凸显了考虑为那些对常规心脏起器修改或提取有禁忌的患者提供无节奏器的重要性.
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