心臟植入性電子儀器病患之圍術期的評估及處置

吳智中 ； 鄭宏煒

《臨床醫學月刊》 90卷5期 (2022/11) Pp. 715-718

https://doi.org/10.6666/ClinMed.202211_90(5).0117

摘要

全世界使用心臟植入性電子儀器（cardiac implantable electronic devices, CIEDs）包含心臟節律器（pacemaker）及植入式去顫器（implantable cardioverter-defibrillator）的人口逐年增加，且此族群對侵入性治療的需求頻率較高，然而手術中常使用的電刀（electrosurgical unit, ESU）、神經刺激器（nerve stimulators）、經皮神經電刺激器（transcutaneous electrical nerve stimulator, TENS）及碎石手術（lithotripsy）、射頻燒灼術（radiofrequency ablation）等等都可能造成電磁干擾而影響心臟植入性電子儀器的正常功能，因此圍術期的評估及處置至關重要。臨床醫師應根據病人病況及心臟植入性電子儀器的功能、設定及廠牌型號等資訊，制定適當的圍術期計畫，以保障病患安全。

關鍵字

心臟植入性電子儀器（cardiac implantable electronic devices, CIEDs） ； 心臟節律器（pacemaker） ； 植入式去顫器（implantable cardioverter-defibrillator） ； 圍術期

參考文獻

Rozner MA, Schulman PM. Creating an Anesthesiologist-run Pacemaker and Defibrillator Service: Closing the Perioperative Care Gap for These Patients. Anesthesiology 2015;123:990

Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Erratum. Anesthesiology 2020;132:938.

Crossley GH, Poole JE, Rozner MA, et al. The Heart Rhythm Society(HRS)/American Society of Anesthesiologists(ASA)Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists(ASA), and in collaboration with the American Heart Association(AHA), and the Society of Thoracic Surgeons(STS). Heart Rhythm 2011;8:1114.

Schulman PM, Treggiari MM, Yanez ND, et al. Electromagnetic Interference with Protocolized Electrosurgery Dispersive Electrode Positioning in Patients with Implantable Cardioverter Defibrillators. Anesthesiology 2019; 130:530.

Robinson TN, Varosy PD, Guillaume G, et al. Effect of radiofrequency energy emitted from monopolar "Bovie" instruments on cardiac implantable electronic devices. J Am Coll Surg 2014;219:399.