SU1517967A1 - Method of treatment of electrode infected heart - Google Patents

Abstract

The invention relates to medicine, in particular to cardiac surgery and the treatment of cardiac arrhythmias. The purpose of the invention is the prevention of heart rhythm disorders and mechanical damage to the heart in patients with endocardial electrodes by electrical destruction of the fibrous capsule around the distal end of the electrode with an electrical pulse with electrical energy that is at least 70 times higher than the electric power of the constant pacing mode, and simultaneously with the electrical destruction of the capsule passive traction for the prokimalny end of the electrode with a weight of 750-780 g. The treatment by the proposed method makes it possible to eliminate and in the form of gastric progression tachycardia and ventricular fibrillation

mechanical myocardial damage in the area of contact with the distal end of the electrode, with the development of cardiac tampon

severe hemodynamic depression at the time of traction

breakage or incomplete extraction of the electrode. The proposed method provides a significant reduction in mortality in patients with electrode sepsis.

Description

And: (Acquisition refers to medicine, in particular cardiac surgery and treatment of cardiac arrhythmias.

The goal is to prevent heart rhythm disorders and mechanical damage to the heart when the electrode is removed.

The method is carried out as follows.

Preliminarily, under conditions of an x-ray operating room, a patient with an infected cardiac rhythm system under local anesthesia is isolated from the proximal end of the electrode from the surrounding tissues in the area of its passage to the vein (head, external belt or internal belt). The ligatures securing the electrode to the vein are removed. Slight pulling is performed at the proximal end of the electrode only to confirm intracardial fixation of its distal end. At the same time, the heartbeat is felt through e, 1ect () g.

The patient is placed on an operating table lying on his back under cardiac monitoring. A single attempt is made to remove the electrode by traction for ei o the proximal end of the cargo m with a mass not exceeding 750 kg under the control of the blood pressure and the ECS. The llini of this attempt fails to perform an anesthesia and proceed to the transnational electrical destruction of the fibrous cannula around the distal end of the endocardial electrode and its removal.

To the proximal end of the e, tectrod no. I-ped 11 1K) t fixer-1anp1,111 (b.-i t 1am: n p load weighing 7.50-780 i and cathode de (} 1bri1l torus. Standard anode from apparatus d .one

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lefibrillations are placed under the left scapula of the patient. Under. By controlling the telenent-copy copies, the traction is carried out over the microspinal end of the electrode with a force of 750-780 g by the established weight, which ensures the necessary tension of the fibrous capsule around the distal end of the electrode. At the same time, on the screen of an electron-optical-coycch transform; Vidpo displacement of the distal end of the electrode and the left contour of the heart in the upward direction and to the right. Almost simultaneously with a pull over the electrode (1 2 s after the start of traction), a defibrillator pulse of 6 kV is applied to it. After that, on the screen of the electron-optical converter, the distal end of the electrode is shifted to the area of the heart, detached from the endocardium. They perform control; | e efficiency of operation; |.: 1antirovannyi EC (, LD, ECG. Perform the distant P1, already active traction for the proximal PI1.1c end of the electrode, until its complete perception) If necessary, provide hemostasis.

The operation is completed by debridement of the wound, its plugging by suturing (as indicated).

Vetichina supplied to the remote e.1ectrod e. 1ektroeppergpi obtained experimentally and clinically. When applying e: 1kt) o-e 1 rgii, 70 times iriv |, | tsaniuyu energy) e- ima permanent n.K. cardiopathy. around the distal end of the electrode along the c-. (irradiated s (Ya1a destruction (1.0-- 1.5 mm in diameter) with a zone of loosening of the fibrous capsules1 1 and immediately around the electrode. The strip of myocardial ischemia around the zone .1est (1 active changes) | ego not exceeding 3 5 mm in diameter and 14 mm beep (, 1. When power is supplied to mepei be.1pchipy (less than 70 times. M) eup1uyu-1pey energy of the mode constant e.1ektrokar- .tsk) stim, 1tsii) around the distal end of the electrode by in-the zone of destruction, is not sufficient) {for a full mobilization of P1 (|) ibrozno 11 kais. 1s. 1 at one single t supply of electricity and ktpoelergii Ud.n-ip e.chektroda.

One stimulating electric pulse of a pacemaker with an amplitude amplitude of 6 mV carries energy from 36x10 to 93.3x10 J and pulse duration from 0.5 to 1.3 ms. Characteristics stimuliruyuschek) imu.lsa e. 1 cardiac pacemaker (almost ideally ngpchpy. P ariab. Papa gii and dura tion, 1 stimulate stimuli traveling a pulse (in part, og ap11a) attack to the device (.

The electrical destruction of the fibrous capsule in the clinical practice is carried out by the following electrical values (1 H) and the pulp

0

five

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five

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five

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sa: duration and pulse 0.5–1.3 ms, pulse energy 200–400 J, pulse voltage amplitude values 5000–7000 V. Drug treatment is an essential element in the fight against infection, but it plays a supporting role a challenging and challenging goal. The main thing is a complete, fast and guaranteed radical removal of the infected legs on the electrode.

Example.Bolna G. .. 76 years. Diagnosis: searching for heart disease, atherosclerotic and post-infarction cardiosclerosis. Complete atrio-ventricular heart block. Right ventricular pacing for 5 years. Suppuration of the electro-cardiac pacemaker bed, circulatory impairment PB Art. Taking into account the threat of the development of sepsis, deimplantation of electrocardiosity is performed, but my patient has vital signs. iHToj: ia from his box with the village. 1dued.1 rehabilitation of the source of infection. After that, the second stage in the X-ray operating conditions was the complete removal of the infected endocardial electrode with a pulse of energy 200-400 J, pulse amplitude 6 kV, with a simultaneous pull over the proximal end of the electrode with a load of 750 g. A new cardiac pacemaker was implanted. In the subsequent period, the period of treatment was carried out with complex disintoxication therapy using antibiotics, immunopreparations, stimulating and general strengthening therapy. The bolp was discharged in satisfactory condition on day 30 after surgery. There were no infectious diseases (observation period 2 years).

(lusob applied in the treatment of 41

The proposed method provides a reduction in mortality in the group of bol1) 11Y. with electrode sepsis 2.6 times (lethality versus 85 / in the prototype). The number of postoperative bed-days for 35 ± 10. In addition, there were no complications in the form of ventricular tachycardia and ventricular fibrillation of the heart; mechanical myocardial damage in the area of contact with the distal end of the electrode with the development of cardiac tamponade; severe hemodynamic depression at the moment of grace; breakage or incomplete extraction of the electrode.

Claims (1)

Formula invented 1 { The method of treatment of electrode infection of the heart, including the simultaneous removal of the electrode by traction for its proximal end, with simultaneous appropriate medical therapy 1517967 56 her, characterized in that, for the purpose of profiling the end of the electrode by electrical impulses of heart rhythm disturbances and me-som with electricity, not less than 70 times When heart failure occurs, the electrolysis mode of the electrode is over-electrified, additional electrocardiostimulation is performed, and a fibrous capsule around the floor is carried to the fibrous capsule around 750-780 g.