经静脉植入式心脏复律除颤器导线拔除过程中施加的力。
Forces applied during transvenous implantable cardioverter defibrillator lead removal.
作者信息
Lennerz Carsten, Pavaci Herribert, Grebmer Christian, von Olshausen Gesa, Semmler Verena, Buiatti Alessandra, Reents Tilko, Ammar Sonia, Deisenhofer Isabel, Kolb Christof
机构信息
Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Fakultät für Medizin, Technische Universität München, Lazarettstraße 36, 80636 München, Germany.
Klinikum rechts der Isar, 1. Medizinische Klinik, Fakultät für Medizin, Technische Universität München, Ismaninger Straße 2, 81675 München, Germany.
出版信息
Biomed Res Int. 2014;2014:183483. doi: 10.1155/2014/183483. Epub 2014 May 21.
METHODS
17 physicians, experienced in transvenous lead removal, performed a lead extraction manoeuvre of an ICD lead on a torso phantom. They were advised to stop traction only when further traction would be considered as harmful to the patient or when--based on their experience--a change in the extraction strategy was indicated. Traction forces were recorded with a digital precision gauge.
RESULTS
Median traction forces on the endocardium were 10.9 N (range from 3.0 N to 24.7 N and interquartile range from 7.9 to 15.3). Forces applied to the proximal end were estimated to be 10% higher than those measured at the tip of the lead due to a friction loss.
CONCLUSION
A traction force of around 11 N is typically exerted during standard transvenous extraction of ICD leads. A traction threshold for a safe procedure derived from a pool of experienced extractionists may be helpful for the development of required adequate simulator trainings.
方法
17名有经静脉导线拔除经验的医生在躯干模型上对植入式心脏除颤器（ICD）导线进行拔除操作。建议他们仅在进一步牵引会被认为对患者有害时，或根据他们的经验表明需要改变拔除策略时停止牵引。用数字精密测量仪记录牵引力。
结果
心内膜上的中位牵引力为10.9牛（范围为3.0牛至24.7牛，四分位间距为7.9至15.3）。由于摩擦损失，施加于导线近端的力估计比在导线尖端测量的力高10%。
结论
在ICD导线的标准经静脉拔除过程中，通常会施加约11牛的牵引力。从经验丰富的拔除医生群体中得出的安全操作牵引阈值，可能有助于开展所需的充分模拟训练。
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