目的：评价在CIED植入中镇静联合局部麻醉的可行性、安全性和患者满意度。方法：回顾性分析2020年1月到2020年12月在上海交通大学医学院附属仁济医院心内科行CIED植入的123例患者，按照麻醉方式分为镇静组和清醒组，镇静组患者术前禁食10小时，消毒后应用镇静药物(咪达唑仑0.03~0.04
mg/kg，丙泊酚0.4~0.6
mg/kg，芬太尼0.5 μg/kg)，然后再按常规利多卡因局部麻醉皮肤切口后植入起搏器。清醒组患者常规消毒铺巾，手术切口附近利多卡因局麻后行常规手术。统计分析两组术中生命体征，术后疼痛评分和手术满意率。结果：与清醒组相比，镇静组的平均动脉压和呼吸频率在术中30 min和手术结束时虽有降低，但均在正常范畴。术后疼痛评分以及手术满意度方面显著优于清醒组，(P < 0.01)。结论：在有效、合理、规范化护理保障下，镇静联合局部麻醉不仅能使患者更好的配合起搏器植入术，还能减轻患者痛苦，使患者有更好的手术体验。
Objective: To evaluate the
feasibility, safety and patient satisfaction of sedation combined with local
anesthesia in CIED implantation. Method: There is a retrospective analysis of
123 cases of patients undergoing CIED implantation ranging from January 2020 to
December 2020 in cardiology department, Renji hospital affiliated to Shanghai
jiao tong university school of medicine. According to the way of anesthesia,
cases were divided into sedation group and sober group. For sedation group,
patients with preoperative fasting for 10 hours were applicated of sedative
drugs (midazolam 0.03~0.04 mg/kg, propofol 0.4~0.6 mg/kg, fentanyl 0.5 μg/kg)
after disinfection. The pacemaker was then implanted after a skin incision
under regular local infiltration anesthesia with lidocaine. As for the sober
group patients, after skin preparation and draping, they underwent local
anesthesia with lidocaine near the surgical incision. The intra-operative vital
signs, postoperative pain score and surgical satisfaction rate of the two
groups were statistically analyzed. Results: Compared to the sober group, the
mean arterial pressure and respiratory rate of the sedated group were decreased
at 30 min and at the end of the operation, but they were all in the normal
range. The postoperative pain score and surgical satisfaction were significantly
better than those of the sober group, (P < 0.01). Conclusion: Under the effective, reasonable and standardized nursing guarantee, Sedation combined with local anesthesia can improve patient cooperation and ease pain during operation, thus getting a better experience in CIED implantation
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