目的 探讨体质量< 8 kg患儿行起搏器治疗的策略。方法 回顾分析2009—2019年间收治的24例体质量< 8 kg，行永 久性起搏器植入术患儿的临床资料。结果 24例患儿中，男16例、女8例，中位年龄6.5个月（1~22个月），中位体质量6 . 4 kg（2.4~ 7 . 9 kg），术后随访1 ~ 120个月，中位随访20.5个月。其中15例患儿行心内膜起搏，9例行心外膜起搏。15例患儿行心内膜起搏后发 生囊袋感染3例，分别表现为囊袋局部血肿、渗出、手术切口裂开；3例患儿均行静脉抗感染治疗，其中表现为囊袋渗出及手术切口 裂开的2例患儿行囊袋清创术，彻底消毒起搏发生器，另1例患儿家属拒绝再行清创术；心内膜起搏后因起搏器功能异常行二次手 术3例，其中1例因三尖瓣反流加重于术后3个月更换导线，1例因起搏器感知不良于术后6年更换导线及发生器，1例术后9年因电 量耗竭再行起搏器植入，考虑双腔起搏可能更符合生理特性，更换起搏模式。9例患儿行心外膜起搏术后因导线或起搏器功能异常行 二次手术2例，均为电量过早耗竭，分别于术后1.5年及2年更换为心内膜起搏，使用周期较短。结论 体质量< 8 kg患儿经心内膜 及心外膜行永久性起搏器植入均具有可行性，且在严控指征下安全有效，但需注意囊袋感染，并在术中及随访中需谨慎三尖瓣反流 问题。

Objective To explore the strategy of pacemaker treatment in children weighing less than 8 kg. Methods The clinical data of 24 patients weighing less than 8 kg who underwent permanent pacer implantation in Shanghai Children's Medical Center from 2009 to 2019 were retrospectively analyzed. Results The median age of the 24 children ( 16 boys and 8 girls) was 6 . 5 months ( 1 - 22 months), the median weight was 6 . 4 kg ( 2 . 4 - 7 . 9 kg), and the median postoperative follow-up time was 20 . 5 months ( 1 - 120 months). Endocardial pacing was performed in 15 cases and epicardial pacing was performed in 9 cases. After endocardial pacing, capsular infection occurred in 3 of the 15 children and manifestations were local capsular hematoma, exudation, and surgical incision dehiscence respectively. All three children received intravenous anti-infective therapy. Two cases with exudation and surgical incision dehiscence underwent pocket debridement and re-embedded generator; the other one refused debridement. After endocardial pacing, 3 cases underwent second operation due to abnormal pacemaker function. In one case, the lead was replaced 3 months after operation due to tricuspid regurgitation. The lead and generator were replaced 6 years after operation in 1 case due to poor pacemaker perception. One patient underwent pacemaker implantation due to power depletion 9 years after surgery and the pacing mode was replaced considering that double-chamber pacing might be more in line with physiological characteristics. In 9 children who had epicardial pacing, two underwent second operation due to abnormal function of lead or pacemaker because of premature power depletion and they were replaced with endocardial pacemaker 1 . 5 and 2 years after the operation respectively. Conclusion Permanent pacemaker implantation via endocardium and epicardium for children under 8 kg is feasible, and is safe and effective under strict control indications. However, it needs to watch for capsular infection and tricuspid regurgitation during the operation and follow-up.