Bollmann A, Kanuru N K, DeLurgio D, Walter P F, Burnette J C, Langberg J J
Section of Cardiac Electrophysiology, Emory University Hospital, Atlanta, Georgia 30322, USA.
J Interv Card Electrophysiol. 1997 Nov;1(3):221-5. doi: 10.1023/a:1009768806894.
Recent technological advances in implantable defibrillator systems (ICD) have changed implantation approaches. The aim of this study was to investigate the influence of these improvements on procedure times, implant-related charges, patient recovery, and morbidity. Ninety-six consecutive patients undergoing implantation of a nonthoracotomy ICD were studied. Implantation was performed under general anesthesia with the generator placed abdominally in 22 patients (group I) and pectorally in 40 patients (group II). Thirty-four patients underwent pectoral implantation using conscious sedation (group III). Groups were comparable with respect to clinical variables. Implantation duration and total procedure duration were shorter in group III (67 +/- 21 minutes and 117 +/- 30 minutes) when compared with group I (100 +/- 25 minutes and 157 +/- 39 minutes) and group II (86 +/- 24 minutes and 153 +/- 34 minutes, P < 0.05). Patients in group III did not require admission to the Post-Anesthesia Care Unit. In contrast, patients in groups I and II spent 92 +/- 28 minutes and 91 +/- 31 minutes in the Post-Anesthesia Care Unit. Implantation-related charges were reduced in patients having pectoral implantation using conscious sedation ($1451 +/- 217 vs. $2354 +/- 550 and $2796 +/- 384, P < 0.05). Patients in group III had a lower frequency of postoperative oral analgesic use (3.2 +/- 2.7 doses, P < 0.05) and a shortened post-operative length of stay (1.9 +/- 1.6 days, P < 0.05) when compared with groups I (5.7 +/- 4.0 doses and 3.3 +/- 1.4 days) and II (5.2 +/- 3.5 doses and 2.6 +/- 1.1 days). The overall complication rate was low (6.3%), with no differences between groups. Advances in ICD technology have simplified implantation, leading to shorter, less painful, and less expensive procedures.
植入式除颤器系统（ICD）最近的技术进步改变了植入方法。本研究的目的是调查这些改进对手术时间、植入相关费用、患者恢复情况和发病率的影响。对连续96例行非开胸ICD植入术的患者进行了研究。在全身麻醉下进行植入，22例患者（I组）将发生器置于腹部，40例患者（II组）将发生器置于胸部。34例患者采用清醒镇静进行胸部植入（III组）。各组在临床变量方面具有可比性。与I组（100±25分钟和157±39分钟）和II组（86±24分钟和153±34分钟）相比，III组的植入持续时间和总手术持续时间更短（67±21分钟和117±30分钟，P<0.05）。III组患者无需入住麻醉后护理病房。相比之下，I组和II组患者在麻醉后护理病房的时间分别为92±28分钟和91±31分钟。采用清醒镇静进行胸部植入的患者，其植入相关费用降低（1451±217美元对2354±550美元和2796±384美元，P<0.05）。与I组（5. ±4.0剂和3.±天）和II组（5.2±3.5剂和2.6±1.1天）相比，III组患者术后口服镇痛药的使用频率较低（3.2±2.7剂，P<0.），术后住院时间缩短（1.9±1.6天，P<0.05）。总体并发症发生率较低（6.3%），各组之间无差异。ICD技术的进步简化了植入过程，使手术时间更短、疼痛更少且费用更低。
