体表心电图指导下紧急临时心脏起搏

Emergency Temporary Cardiac Pacing Guided by Surface Electrocardiogram

目的 研究在体表心电图指导下行床旁紧急临时心脏起搏技术的可行性和优越性。方法 对16例严重心动过缓性心律失常和6例心搏骤停患者以Seldinger法穿刺左锁骨下静脉置入鞘管。设置起搏器频率为70次／min，输出电压为5．0V，感知电压为2．0mV，沿鞘管推送电极至体表心电图显示脉冲信号及起搏心律。结果 操作时间2～12min，平均（5．5±2．2）min。2例发生电极脱位，重新调整后起搏正常。16例心律失常患者获良好的起搏效果，6例心搏骤停患者中5例起搏导管到位后无有效起搏夺获，呈电-机械分离，最终抢救失败，余1例起搏成功，但终因原发病不能控制而死亡。结论 在体表心电图指导下行紧急床旁临时心脏起搏操作简单，对缓慢心律失常患者起效迅速、成功率高，对心搏骤停患者抢救效果差。

Objective To investigate the feasibility and merits of emergency bedsidejtemporary cardiac pacing guided by surface electrocardiogram. Methods The left subclavicular vein was punctured with Seldinger technique for inserting a cannula in 22 patients with bad bradycardia or heart arrest. After setting the rate of pacemaker at 70 beat/min with output voltage of 5.0 V and sensing voltage of 2.0 mV, the electrode was inserted through the cannula until the electrocardiograph displaying pulsed signal and pacing rhythm. Results Operating time was 2 - 12 min, average （5.5 ± 2. 2 ） min. No complications occurred in the 22 patients. Good pacing was achieved in 16 patients with two having poor pacing, which was improved by regulating. Electricity - mechanical separation was in 5 patients. Conclusion Emergency bedside temporary cardiac pacing guided by surface electrocardiogram coule work rapidly and ensure the high success rate.