锁骨下静脉穿刺心腔内心电图引导床旁临时起搏术20例报告

Emergency bedside temporary cardiac pacing guided by intercardiac electrocardiogram(ECG) with percutaneous subclavian venipuncture-clinical use in 20 patients

报告２０例严重心动过缓或心脏骤停患者于床旁经锁骨下静脉穿刺心腔内心电图引导植入临时起搏器，均取得成功，未有并发症发生。插入电极导管至右心室完全起搏时间约３０—８０ｓ（中数５５ｓ），自静脉穿刺到固定好电极约需４—１２ｍｉｎ（中数８ｍｉｎ）。左锁骨下静脉利于电极送达右心室，心房与心室内心电图不同可判断电极导管在心腔内的位置，如位于右室。无论电极在任何部位只要起搏好且牢固，即可。本文２０例患者电极７例位于右室心尖部，７例位于右心室流出道，６例位于右心室中部。维持起搏时间２４ｈ到１７天不等。

Serious bradycardia or cardiac arrest in 20 patients was treated with emergency bedside temporary car-diac pacing guided by intercardiac ECG with percutaneous subclavian venipuncture. All cases were success-ful,no complications occurred.The time from which the electrode catheter was positioned in the right ven-tricle to the cardiac pacing was 30 to 80 seconds(median 55 seconds);From percutaneous veniptincture toend of operation needed 4 to 12 minutes(median 8 minutus).The left subclavian vein is better than theright to position electrode at the right ventricle. As atrial and ventricular ECGs are different,the position ofthe electrode in the heart can be jtidged correctly. This article reports that in 20 patients,the electrodecatheter position in the right ventricle is at apex in 7 cases,at outflow tract in 7 cases,and at the middle inthe rest of the cases.