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中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 96 -100. doi: 10.3877/cma.j.issn.2095-6568.2022.02.006

所属专题: 总编推荐

无导线起搏器

无导线起搏器植入术后股静脉血栓的发生及其临床特征
陈学颖1, 汪菁峰1, 梁义秀1, 柏瑾1, 王蔚1, 秦胜梅1, 张磊1, 李明辉1, 陈佳慧1, 宿燕岗1,()   
  1. 1. 200032 上海,复旦大学附属中山医院心内科?上海市心血管病研究所?国家放射与治疗临床医学研究中心
  • 收稿日期:2022-05-06 出版日期:2022-06-25
  • 通信作者: 宿燕岗

The incidence and clinical characteristics of femoral vein thrombus after leadless pacemaker implantation

Xueying Chen1, Jingfeng Wang1, Yixiu Liang1, Jin Bai1, Wei Wang1, Shengmei Qin1, Lei Zhang1, Minghui Li1, Jiahui Chen1, Yangang Su1,()   

  1. 1. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
  • Received:2022-05-06 Published:2022-06-25
  • Corresponding author: Yangang Su
引用本文:

陈学颖, 汪菁峰, 梁义秀, 柏瑾, 王蔚, 秦胜梅, 张磊, 李明辉, 陈佳慧, 宿燕岗. 无导线起搏器植入术后股静脉血栓的发生及其临床特征[J/OL]. 中华心脏与心律电子杂志, 2022, 10(02): 96-100.

Xueying Chen, Jingfeng Wang, Yixiu Liang, Jin Bai, Wei Wang, Shengmei Qin, Lei Zhang, Minghui Li, Jiahui Chen, Yangang Su. The incidence and clinical characteristics of femoral vein thrombus after leadless pacemaker implantation[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(02): 96-100.

目的

探讨无导线起搏器术后股静脉血栓的发生及其临床特征。

方法

连续入选2020年4月到2022年1月在复旦大学附属中山医院接受无导线起搏器植入的患者。所有患者均符合缓慢性心律失常植入单腔起搏器适应证。术后第1天复查股静脉穿刺处彩超,观察股静脉血栓的发生情况及其临床特征,并分析其相关因素。

结果

研究纳入146例无导线起搏器植入术后患者,共4例(2.74%,4/146)患者出现股静脉血栓,年龄(75.75±19.14)岁,其中男3例,均无相关症状。经抗凝治疗后3例患者血栓在1个月后消失,1例在2个月后消失,未出现血栓栓塞等不良后果。股静脉血栓者D-二聚体水平(>0.5 mg/L)术前1例升高,术后3例升高,但术前和术后比较差异无统计学意义[0.33(0.26,0.94)mg/L对1.49(0.67,2.17)mg/L,P=0.057]。Spearman相关分析发现无导线起搏器术后股静脉血栓与术后D-二聚体升高呈显著正相关(r=0.239,P=0.037),而与年龄、性别、体重、合并症(心房颤动、高血压、糖尿病)、基线超声心动图参数、术前D-二聚体升高、X线曝光时间、伤口闭合方式等均无显著相关性(P均>0.05)。

结论

无导线起搏器术后股静脉血栓发生率较低,无导线起搏器术后复查D-二聚体和穿刺点血管超声有助于及时发现股静脉血栓并及时开启抗凝治疗。

Objective

To investigate the incidence and clinical characteristics of femoral vein thrombus after leadless pacemaker implantation.

Methods

The patients received leadless pacemaker implantation in Zhongshan Hospital, Fudan University from April 2020 to January 2021 were consecutively included. All of the patients suffered from bradycardia were indicated for a single chamber pacemaker implantation and received femoral vein ultrasound at the first day post-procedure. The incidence and the clinical characteristics were described and the correlation factors were analyzed.

Results

One hundred and forty-six patients were enrolled. The incidence of femoral vein thrombus was 2.74% (4/146). The average age of these 4 cases was (75.75±19.14) years old with 3 males,and all the patients were asymptomatic. During follow-up, there were no adverse outcomes happened, including thromboembolism with the thrombus. The femoral vein thrombus of 3 cases disappeared at 1 month's follow-up, and 1 case disappeared at 2 months post-procedure. In thrombus group, elevation of D-dimmer (>0.5 mg/L) were documented in 1 case (25.00%) pre-procedure, and 3 cases (75.00%) post-procedure while the median level of D-dimmer pre-procedure were not significantly different as compared to post-procedure [0.33(0.26,0.94) mg/L vs.1.49(0.67,2.17) mg/L,P=0.057)].The occurrence of femoral vein thrombus after leadless pacemaker implantation was significantly associated with D-dimmer elevation post-procedure by Spearman correlation analysis (r=0.239,P=0.037). While it was not significantly correlated to the other factors including age, gender, body weight, comorbidities (atrial fibrillation, hypertension and diabetes), baseline echocardiographic parameters, D-dimmer elevation pre-procedure, fluoroscopic time and closure methods (all P>0.05).

Conclusion

The incidence of femoral vein thrombus was rather low. Monitoring D-dimmer and performing puncture site ultrasound post-procedure are helpful to detect femoral vein thrombus and start anticoagulation in time.

图1 1例植入无导线起搏器后患者彩超显示股总静脉内血栓形成(箭头处)
表1 4例植入无导线起搏器后出现股静脉血栓患者的具体情况
图2 基线和术后第1天D-二聚体在股静脉血栓组和无血栓组对比[2A为两组D-二聚体中位数水平对比;2B为两组D-二聚体升高百分比对比]
表2 无导线起搏器植入术后股静脉血栓的相关因素分析
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