Elmistekawy Elsayed, Gee Yen-Yen, Une Dai, Lemay Matthieu, Stolarik Anne, Rubens Fraser D
University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, Ontario, K1Y 4 W7, Canada.
J Cardiothorac Surg. 2016 Jan 16;11:8. doi: 10.1186/s13019-016-0414-2.
Temporary pacemaker wires are placed in the majority of patients after cardiac surgery. There is no information on mechanical factors related to wire removal.
Clinical information related to temporary wire use and removal was prospectively collected from a large cardiac surgical unit over one year. Measurements of maximal tension that nurses and doctors would apply to remove temporary wires was determined using a hand-held portable scale. In a prospective trial, patients (n = 41) had their wires extracted in series to the portable scale to determine the maximal tension required for safe removal.
Ventricular wires were placed in 86.5 % of patients during the observed year. Pacing facilitated weaning from CPB in over 15 % of patients and pacer dependence was seen in 2.1 %. No patients suffered major complications after wire removal. There was no difference in the tension that physicians or nurses would apply to comfortably extract temporary wires. In the prospective trial, there was no difference in the tension required for removal of atrial or ventricular wires (atrial 18.3 ± 17.9 oz versus 14.5 ± 14.2 oz, p = 0.430). There were no patient factors that correlated with the degree of resistance and there was no significant difference between the tension required to remove wires with (21.0 ± 22.5 oz) or without (14.1 ± 5.1 oz) an atrial button.
Temporary epicardial wire removal is innocuous and was not associated with any complications. In some patients tension required for safe removal exceeded 20 ounces. Strategies to standardize wire removal may prevent complications and may minimize unnecessary wire retention.
大多数心脏手术后的患者会留置临时起搏器导线。目前尚无关于导线拔除相关机械因素的信息。
前瞻性收集了一家大型心脏外科单位一年内与临时导线使用和拔除相关的临床信息。使用手持式便携秤测定护士和医生拔除临时导线时施加的最大张力。在一项前瞻性试验中，41例患者的导线被依次连接到便携秤上，以确定安全拔除所需的最大张力。
在观察年度内，86.5%的患者留置了心室导线。超过15%的患者通过起搏辅助脱离体外循环，起搏器依赖率为2.1%。导线拔除后无患者出现严重并发症。医生或护士舒适地拔除临时导线时施加的张力没有差异。在前瞻性试验中，拔除心房或心室导线所需的张力没有差异（心房导线为18.3±17.9盎司，心室导线为14.5±14.2盎司，p=0.430）。没有患者因素与阻力程度相关，有或没有心房按钮时拔除导线所需的张力之间也没有显著差异（有按钮时为21.0±22.5盎司，无按钮时为14.1±5.1盎司）。
临时心外膜导线拔除是无害的，且与任何并发症均无关联。在一些患者中，安全拔除所需的张力超过20盎司。规范导线拔除的策略可能预防并发症，并可尽量减少不必要的导线留置。
