摘要目的:探讨术式优化对全皮下植入型心律转复除颤器（S-ICD）长期安全性及有效性的影响。方法:本研究为单中心回顾性队列研究。连续纳入2017年1月至2025年8月在新疆医科大学第一附属医院心脏起搏电生理科植入S-ICD的患者，按照术中是否行除颤阈值测试（DFT）、麻醉方式、切口技术进行分组，探讨省略DFT、采用两切口技术及超声引导下肋间神经阻滞对S-ICD的恰当放电（AS）、不恰当放电（IAS）以及并发症发生情况的影响。结果:共纳入241例患者，男197例，年龄为（55.11±14.23）岁，所有患者PRAETORIAN评分均<90分。非DFT组和DFT组患者调整后IAS发生率［0（0/152）对1.1%（1/89）， P=0.369］及术后并发症［2.0%（3/152）对0（0/89）， χ2=0.536， P=0.464］差异均无统计学意义，非DFT组患者AS发生率低［7.9%（12/152）对22.5%（20/89）， χ2=10.359， P=0.001］；两组患者的体重指数（BMI）比较差异无统计学意义［（26.03±4.59）kg/m 2对（26.49±5.95）kg/m 2， t=2.671， P=0.509］，非DFT组多为一级预防［81.6%（124/152）对61.8%（55/89）， χ2=11.495， P<0.001］，非DFT组手术时间短于DFT组［（46.35±14.77）min对（54.56±20.33）min， t=3.611， P=0.001］。从麻醉方式上评估，肋间神经阻滞和其他麻醉方式比较，调整后IAS［0.5%（1/218）对0（0/23）， P=1.000］和术后并发症［1.4%（3/218）对0（0/23）， P=1.000］的发生率差异均无统计学意义。肋间神经阻滞组患者AS发生率低于其他麻醉方式组患者［11%（24/218）对34.8%（8/23）， χ2=8.251， P=0.004］，且手术时间短［（47.29±15.39）min对（69.22±23.01）min， t=6.156， P<0.001］。在切口技术方面，相较于三切口技术，两切口患者的调整后IAS［0（0/208）对3.0%（1/33）， P=0.137］及并发症发生率［1.4%（3/208）对0（0/33）， P=1.000］差异均无统计学意义，且AS发生率低［11.1%（23/208）对27.3%（9/33）， χ2=5.171， P=0.023］；同时两切口技术组患者手术时间低于三切口技术组［（47.17±16.10）min对（63.36±19.33）min， t=5.217， P<0.001］。长期随访中，S-ICD植入术后需起搏器植入的发生比例为1.2%（3/241）。 结论:对于PRAETORIAN评分<90分的患者，S-ICD植入术中省略DFT、采用两切口技术及超声引导下肋间神经阻滞，在不增加术后并发症或IAS风险的前提下，有助于提高手术效率。

abstractsObjective:To investigate the impact of optimized surgical techniques on the long-term safety and efficacy of subcutaneous implantable cardioverter defibrillator (S-ICD).Methods:This study was a single-center retrospective cohort study. Patients consecutively enrolled at the Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University between January 2017 and August 2025 who underwent S-ICD implantation were grouped based on whether defibrillation threshold testing (DFT) , anesthesia method, and incision technique. The effects of omitting DFT, employing a two-incision technique and performing ultrasound-guided intercostal nerve blockage on appropriate shocks (AS), inappropriate shocks (IAS), and complications were evaluated.Results:A total of 241 patients were enrolled, including 197 males, with a mean age of (55.11±14.23) years. All patients had PRAETORIAN scores<90 points. Patients in the non-DFT group and the DFT group showed no significant difference in adjusted incidence of IAS [0 (0/152) vs. 1.1% (1/89), P=0.369] and postoperative complications [2.0% (3/152) vs. 0 (0/89), χ2=0.536, P=0.464), The incidence of AS was lower in the non-DFT group [7.9% (12/152) vs. 22.5% (20/89), χ2=10.359, P=0.001]. Body mass index (BMI) showed no significant difference between the two groups [(26.03±4.59) kg/m 2 vs. (26.49±5.95) kg/m 2, t=2.671, P=0.509]. The non-DFT group predominantly underwent primary prevention [81.6% (124/152) vs. 61.8% (55/89), χ2=11.495, P<0.001], and the non-DFT group had shorter operative times than the DFT group [(46.35±14.77) min vs. (54.56±20.33) min, t=3.611, P=0.001]. When evaluating anesthetic techniques, intercostal nerve block compared with other anesthesia groups showed no statistically significant difference in adjusted IAS incidence [0.5% (1/218) vs. 0 (0/23), P=1.000] or postoperative complications [1.4% (3/218) vs. 0 (0/23), P=1.000]. Patients in the intercostal nerve block group exhibited a lower incidence of AS compared to other anesthesia group [11% (24/218) vs. 34.8% (8/23), χ2=8.251, P=0.004], additionally, their operative time was shorter [(47.29±15.39) min vs. (69.22±23.01) min, t=6.156, P<0.001]. Regarding incision techniques, compared to the three-incision approach, the two-incision group showed no statistically significant difference in the adjusted IAS [0 (0/208) vs. 3.0% (1/33), P=0.137] or complications [1.4% (3/208) vs. 0 (0/33), P=1.000], while exhibiting a lower AS incidence [11.1% (23/208) vs. 27.3% (9/33), χ2=5.171, P=0.023]. Additionally, patients in the two-incision technique group had shorter operative times compared to the three-incision technique group [(47.17±16.10) min vs. (63.36±19.33) min, t=5.217, P<0.001]. Long-term follow-up revealed a 1.2%(3/241) incidence of pacemaker implantation following S-ICD placement. Conclusion:In patients with PRAETORIAN scores below 90, omitting DFT during S-ICD implantation, employing a two-incision technique, and performing ultrasound-guided intercostal nerve blockage can enhance the S-ICD implantation surgical efficiency without increasing the risk of postoperative complications or inappropriate shocks.