心血管植入型电子器械植入术护理专家共识Expert consensus on operative nursing management of cardiovascular implantable electronic devices
朱雪清,何朝凯,陈太波,王晶婧,高学琴,苏州工业园区东方华夏心血管健康研究院 ,海峡两岸医药卫生交流协会护理分会心血管护技专业学组
摘要(Abstract):
随着心血管介入诊疗技术的快速发展,心血管植入型电子器械(CIED)植入技术日臻成熟。术中护理在确保手术成功、降低并发症风险、改善患者预后质量中起到至关重要的作用。但目前缺乏全面系统的CIED手术术中护理指导文件。本专家共识通过综合回顾国内外相关文献,结合丰富的临床实践经验,系统总结了CIED术中护理的关键环节,涵盖患者安全核查、术前准备、术中护理、术中并发症的观察与响应、健康教育5个主题,旨在为临床护理人员提供标准化、系统化的操作指南,提升术中护理的安全性与有效性,推动我国CIED植入术中护理朝着健康、规范、同质化的方向发展。
关键词(KeyWords): 心血管植入型电子器械;术中护理;专家共识
基金项目(Foundation):
作者(Author): 朱雪清,何朝凯,陈太波,王晶婧,高学琴,苏州工业园区东方华夏心血管健康研究院 ,海峡两岸医药卫生交流协会护理分会心血管护技专业学组
参考文献(References):
- [1]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.植入型心律转复除颤器临床应用中国专家共识(2021)[J].中华心律失常学杂志,2021,25(4):280-299.DOI:10.3760/cma.j.cn.113859-20210315-00054.
- [2]曹文君,顾益君,葛思佳,等.基于知识转化模式构建永久性心脏起搏器植入术后患者肩关节活动方案[J].中国辐射卫生,2021,30(6):782-787.DOI:10.13491/j.issn.1004-714X.2021.06.024.
- [3] Kornej J,B??rschel CS,Benjamin EJ,et al.Epidemiology of atrial fibrillation in the 21st Century:novel methods and new insights[J].Circ Res,2020,127(1):4-20.DOI:10.1161/CIRCRESAHA.120.316340.
- [4]刘明波,何新叶,杨晓红,等.《中国心血管健康与疾病报告2023》概要(心血管疾病流行及介入诊疗状况)[J].中国介入心脏病学杂志,2024,32(10):541-550.DOI:10.3969/j.issn.1004-8812.2024.10.001.
- [5]Thomas H,Plummer C,Wright IJ,et al.Guidelines for the peri-operative management of people with cardiac implantable electronic devices:guidelines from the British Heart Rhythm Society[J].Anaesthesia,2022,77(7):808-817.DOI:10.1111/anae.15728.
- [6] Blomstr??m-Lundqvist C,Traykov V,Erba PA,et al.European Heart Rhythm Association(EHRA)international consensus document on how to prevent,diagnose,and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society(HRS),the Asia Pacific Heart Rhythm Society(APHRS),the Latin American Heart Rhythm Society(LAHRS),International Society for Cardiovascular Infectious Diseases(ISCVID)and the European Society of Clinical Microbiology and Infectious Diseases(ESCMID)in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS)[J].Europace,2020,22(4):515-549.DOI:10.1093/europace/euz246.
- [7]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.心血管植入型电子器械术后随访的专家共识(2020)[J].中华心律失常学杂志,2020,24(6):532-544.DOI:10.3760/cma.j.cn.113859-20201027-00278.
- [8]Glikson M,Nielsen JC,Kronborg MB,et al.2021ESC Guidelines on cardiac pacing and cardiac resynchronizationtherapy[J].Eur Heart J,2021,42(35):3427-3520.DOI:10.1093/eurheartj/ehab 3 64.
- [9]陈耀龙,杨克虎,王小钦,等.中国制订/修订临床诊疗指南的指导原则(2022版)[J].中华医学杂志,2022,102(10):697-703.DOI:10.3760/cma.j.cn112137-20211228-02911.
- [10] Balshem H,Helfand M,Schünemann HJ,et al.GRADE guidelines:3.Rating the quality of evidence[J].J Clin Epidemiol,2011,64(4):401-406.DOI:10.1016/j.jclinepi.2010.07.015.
- [11]中国医师协会心血管内科医师分会结构性心脏病学组,亚太结构性心脏病俱乐部.中国经导管主动脉瓣置换术临床路径专家共识(2024版)[J].中国介入心脏病学杂志,2024,32(11):601-617.DOI:10.3969/j.issn.1004-8812.2024.11.001.
- [12]方陈,李亚菲,张琼,等.手术安全核查的SWOT分析[J].解放军医院管理杂志,2019,26(4):301-305.DOI:10.16770/J.cnki.1008-9985.2019.04.001.
- [13]孙建华,汤彩虹,陈丽萍.规范手术病人边缘时间安全转运交接的品管圈实践[J].循证护理,2024,10(8):1450-1454.DOI:10.12102/j.issn.2095-8668.2024.08.025.
- [14]陈红,何国龙,张春瑾,等.智能化手术安全核查流程的设计与应用[J].护理学杂志,2024,39(21):51-54.DOI:10.3870/j.issn.1001-4152.2024.21.051.
- [15]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.普通心脏起搏器和植入型心律转复除颤器手术操作规范中国专家共识(2023)[J].中华心律失常学杂志,2023,27(3):188-224.DOI:10.3760/cma.j.cn113859-20230316-00044.
- [16]马骋宇.运动康复对植入复律除颤器或心脏再同步治疗的心衰患者影响的系统评价及Meta分析[D].山西:山西医科大学,2021.
- [17]汪菁峰,汗祖热木·托合提,梁义秀,等.心血管植入型电子器械围术期不同抗栓策略的对比研究[J].中华心律失常学杂志,2019,23(4):341-347.DOI:10.3760/cma.j.issn.1007-6638.2019.04.014.
- [18]Burri H,Starck C,Auricchio A,et al.EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverterdefibrillators:endorsed by the Heart Rhythm Society(HRS),the Asia Pacific Heart Rhythm Society(APHRS),and the Latin-American Heart Rhythm Society(LAHRS)[J].Europace,2021,23(7):983-1008.DOI:10.1093/europace/euaa367.
- [19]Joglar JA,Chung MK,Armbruster AL,et al.2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2024,149(1):el-e156.DOI:10.1161/CIR.0000000000001193.
- [20]Steffel J,Verhamme P,Potpara TS,et al.The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J].Eur Heart J,2018,39(16):1330-1393.DOI:10.10 93/eurheartj/ehy 136.
- [21]Douketis JD,Spyropoulos AC,Murad MH,et al.Perioperative management of antithrombotic therapy:an American College of Chest Physicians Clinical Practice Guideline[J].Chest,2022,162(5):e207-e243.DOI:10.1016/j.chest.2022.07.025.
- [22]Bimie DH,Healey JS,Wells GA,et al.Pacemaker or defibrillator surgery without interruption of anticoagulation[J].N Engl J Med,2013,368(22):2084-2093.DOI:10.1056/NEJMoa1302946.
- [23]丁鹏飞.起搏器植入围术期抗栓药物应用与术后出血事件的观察[D].山西:山西医科大学,2017.
- [24] Sandoe JA,Barlow G,Chambers JB,et al.Guidelines forthe diagnosis,prevention and management of implantable cardiac electronic device infection.Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy(BSAC,host organization),British Heart Rhythm Society(BHRS),British Cardiovascular Society(BCS),British Heart Valve Society(BHVS)and British Society for Echocardiography(BSE)[J].J Antimicrob Che mother,2015,70(2):325-359.DOI:10.1093/jac/dku383.
- [25]Verbeek JH,Rajamaki B,Ijaz S,et al.Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff[J].Cochrane Database Syst Rev,2019,7(7):CD11621.DOI:10.1002/14651858.CD011621.pub3.
- [26]中国医师协会心律学专业委员会,中华医学会心电生理和起搏分会.无导线起搏器临床应用中国专家共识(2022)[J].中华心律失常学杂志,2022,26(3):263-271.DOI:10.3760/cma.j.cn113859-20220413-00073.
- [27]Tanner J,Melen K.Preoperative hair removal to reduce surgical site infection[J].Cochrane Database Syst Rev,2021,8(8):CD4122.DOI:10.1002/14651858.CD004122.pub5.
- [28]王天龙,黄宇光.推动麻醉学向围手术期医学转变:《加速康复外科中国专家共识及路径管理指南(2018版)》麻醉部分解读[J].协和医学杂志,2018,9(6):481-484.DOI:10.3969/j.issn.1674-9081.2018.06.001.
- [29]庄珊珊,张转运,傅双,等.择期全麻患者术前禁食禁饮管理的最佳证据总结[J].中华护理杂志,2022,57(14):1749-1755.DOI:10.3761/j.issn.0254-1769.2022.14.013.
- [30]Han HC,Hawkins NM,Pearman CM,et al.Epidemiology of cardiac implantable electronic device infections:incidence and risk factors[J].Europace,2021,23(23 Suppl 4):iv3-iv10.DOI:10.1093/europace/euab042.
- [31]PADIT Calculator[EB/OL].[2025-04-23].https://www.ottawaheart.c a/patients-visitors/clinic s-and-programs/cardiac-device-clinic/padit-calculato r.
- [32] de Heide J,van der Graaf M,Holl MJ,et al.Device infection in patients undergoing pacemaker or defibrillator surgery:risk stratification using the PADIT score[J].J Interv Card Electrophysiol,2024,67(6):1419-1426.DOI:10.1007/s 10840-024-01759-1.
- [33]Birnie DH,Wang J,Alings M,et al.Risk factors for infections involving cardiac implanted electronic devices[J].J Am Coll Cardiol,2019,74(23):2845-2854.DOI:10.1016/j.jacc.2019.09.060.
- [34] Blo mstro m-Lundqvist C,Ostrowska B.Prevention of cardiac implantable electronic device infections:guidelines and conventional prophylaxis[J].Europace,2021,23(Suppl4):iv11-iv19.DOI:10.1093/europace/euab071.
- [35]国家标准-全国标准信息公共服务平台[EB/OL].2025-04-23].https://std.samr.gov.cn/gb/search/gbDetailed?id=F78920660FF2B223E05397BE0A0AE533.
- [36]BischoffP,Kubilay NZ,Allegranzi B,et al.Effect of laminar airflow ventilation on surgical site infections:a systematic review and meta-analysis[J].Lancet Infect Dis,2017,17(5):553-561.DOI:10.1016/S1473-3099(17)30059-2.
- [37]李乐,郑黎晖.心脏起搏器置入术的相关并发症及围术期管理[J].中国临床医生杂志,2022,50(9):1017-1019.DOI:10.3969/j.issn.2095-8552.2022.09.003.
- [38]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.全皮下植入型心律转复除颤器中国专家共识(2023)[J].中华心律失常学杂志,2023,27(5):376-389.DOI:10.3760/cna.j.cn113859-20230828-00015.
- [39]中华医学会放射学分会护理工作组.介入手术室医院感染控制和预防临床实践专家共识[J].介入放射学杂志,2022,31(6):531-537.DOI:10.3969/j.issn.1008-794X.2022.06.002.
- [40]Stühlinger M,Burri H,Vernooy K,et al.EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices[J].Europace,2022,24(9):1512-1537.DOI:10.1093/europace/euac040.
- [41]Ferrick AM,Raj SR,Deneke T,et al.2023 HRS/E HRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic[J].Heart Rhythm,2023,20(9):e92-e144.DOI:10.1016/j.hrthm.2023.03.1525.
- [42]Surgical wound dehiscence(SWD):international consensus statement on assessment,diagnosis and managementWounds International[EB/OL].[2025-05-09].https://woundsinternational.com/consensus-documents/surgicalwound-dehiscence-swd-international-consensus-statement-onassessment-diagnosis-and-management/.
- [43]Global guidelines for the prevention of surgical site infection[M].Geneva:World Health Organization,2016.
- [44]Weiss R,Mark GE,El-Chami MF,et al.Process mapping strategies to prevent subcutaneous implantable cardioverterdefibrillator infections[J].J Cardiovasc Electrophysiol,2022,33(7):1628-1635.DOI:10.1111/jce.15566.
- [45] Roberts ME,Rahman NM,Maskell NA,et al.British Thoracic Society Guideline for pleural disease[J].Thorax,2023,78(11):1143-1156.DOI:10.1136/thorax-2023-220304.
- [46]Discalzi A,Maglia C,Ciferri F,et al.Percutaneous closure of accidentally subclavian artery catheterization:time to change first line approach?[J].CVIR Endovasc,2022,5(1):23.DOI:10.1186/s4215 5-022-00300-7.
- [47] Chen X,Bai J,Han F,et al.Percutaneous closure of the inadvertent subclavian artery cannulation during pacemaker implantation[J].Cardiol J,2017,24(4):452-454.DOI:10.5603/CJ.2017.0093.
- [48]Molnár L,Szucs G,Zima E,et al.Successful management and long term outcome of an accidental subclavian artery injury with a9 french dilator during pacemaker implantation with collagen-based closure device[J].J Interv Card Electrophysiol,2009,25(3):217-218.DOI:10.1007/s 10840-008-9362-7.
- [49] Oliveira VMR,Rivera A,Oliveira IC,et al.The effectiveness and safety of leadless pacemakers:an updated meta-analysis[J].Curr Cardiol Rep,2024,26(8):789-799.DOI:10.1007/s11886-024-02079-6.
- [50]苏州工业园区心血管健康研究院,中国心血管健康联盟心血管病护技培训中心专家委员会.心脏介入诊疗术中并发急性心脏压塞急救与护理专家共识[J].中国介入心脏病学杂志,2022,30(9):644-652.DOI:10.3969/j.issn.1004-8812.2022.09.002.
- [51]张艺民,昃峰,段江波,等.急性心脏电极穿孔的处理策略分析[J].心肺血管病杂志,2024,43(3):244-248.DOI:10.3969/j.issn.1007-5062.2024.03.006.
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