植入式人工心脏起搏器:材料及材料相关并发症

发布时间：2018-07-14 19:33

【摘要】：背景:由于植入式人工心脏起搏器患者需要长期终身佩戴,所以起搏器与人体组织直接接触的材料的生物相容性非常重要。目的:阐述植入式人工心脏起搏器材料进展及与材料相关并发症。方法:检索万方数据库及Pub Med数据库2000至2015年,与人工心脏起搏器材料及与材料相关并发症研究相关的文献,中文检索词为"心脏起搏器;材料;导线;电极;并发症",英文检索词为"Pacemaker;Materials;Pacemaker leads;Pacemaker electrode;Complication",以上检索词组合检索,筛选符合纳入标准的25篇文献进行总结。结果与结论:人工心脏起搏器与人体组织直接接触的材料主要有封装脉冲发生器的钛金属外壳,电极导线包覆的绝缘材料硅胶、聚氨酯、环氧树脂等,以及电极材料碳、铂-铱合金、Elgilog合金等。虽然经几十年的临床应用证实,以上材料均具备良好的物理、化学特性,以及与人体的良好细胞相容性、电生理相容性和血液相容性,但材料相关的并发症如起博器接触性皮炎、导线断裂、脱位、心脏穿孔、导线路径中的静脉血栓、三尖瓣反流、放置脉冲发生器的囊袋感染和血肿等时有发生,因此,随着当今材料工程和微电子技术的迅猛发展,起搏器材料改性以及起搏系统工艺改进相关研究一直在进行,并且已经取得了长足的进展,而无导线起搏器的研制及临床应用可能是未来心脏起搏的发展方向。
[Abstract]:Background: because implantable artificial heart pacemakers need to be worn for a long time, biocompatibility between pacemakers and materials in direct contact with human tissues is very important. Objective: to describe the material development and related complications of implanted artificial cardiac pacemaker. Methods: to search Wanfang database and Pub Med database from 2000 to 2015. The Chinese key words were "pacemaker; material; wire; electrode;" Complication ", the English key word is" PacemakerMaterialsPacemaker lead / Pacemaker electrode replication ", the above key words are searched, and 25 articles that meet the inclusion criteria are selected and summarized. Results & conclusion: the materials of direct contact between artificial cardiac pacemakers and human tissues include titanium metal shell encapsulated with pulse generator, insulating materials such as silica gel, polyurethane, epoxy resin, and carbon electrode material. Platinum-iridium alloy Elgilog alloy and so on. Although decades of clinical application have proved that the above materials have good physical and chemical properties, as well as good cytocompatibility, electrophysiological compatibility and blood compatibility with the human body, But material related complications such as pacemaker contact dermatitis, wire breakage, dislocation, heart perforation, venous thrombosis in the traverse path, tricuspid regurgitation, bag infection and hematoma placed in the pulse generator occur from time to time, so, With the rapid development of material engineering and microelectronic technology, the research of pacemaker material modification and pacing system technology improvement has been carried out, and has made great progress. The development and clinical application of lead-free pacemaker may be the development direction of cardiac pacing in the future.
【作者单位】：辽宁省金秋医院心内科;
【分类号】：R318.11

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