在心脏植入式电子设备的医疗保险患者中,三干预的实践模式和结果
Enrico G Ferro1, Lorenzo V Arvanitis2, Siling Li3
1Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Clinical electrophysiology
|November 7, 2025
概括
穿皮三干预正在增加,特别是在心脏植入式电子设备 (CIED) 的患者中. 在这些程序中提取是常见的和安全的,但整体并发症率仍然很高.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗器械技术 医疗器械技术
背景情况:
- 越来越多地使用皮穿式三门装置,需要证据来管理先前存在的心脏植入式电子设备 (CIED).
- 对于接受三干预的CIED患者,最佳的管理策略 (提取与"监禁") 需要澄清.
研究的目的:
- 分析手术和皮肤穿刺三干预的国家趋势.
- 评估临床结果,重点关注CIED患者.
- 确定影响提取决策的因素.
主要方法:
- 对接受三干预的医疗保险受益人的回顾性分析 (2016-2023年).
- 使用倾向性得分匹配对住院和30天结果进行比较.
- 考克斯回归分析以确定CIED提取的预测因素.
主要成果:
- 皮革三干预显著增加,CIED患者更有可能接受这些手术 (17.2%与7.9%相比).
- CIED提取发生在18.9%的CIED患者中,感染是主要的驱动因素 (35.8%).
- 同时提取并没有增加整体并发症,除了急性损伤 (aOR 1.61).
结论:
- 穿皮三干预越来越多地被采用,特别是患有CIED的患者.
- 提取通常在指示时使用,并且不会增加并发症风险,除非急性损伤.
- 三管干预的高整体并发症率要求谨慎地应用提取程序.
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