一种经头静脉穿刺置入起搏器电极导线的新方法

A new method for implanting pacemaker lead by puncturing cephalic vein

目的：介绍一种经头静脉穿刺置入起搏器电极导线的新方法。方法：对25例需安装双腔或三腔永久人工心脏起搏器的患者进行研究。分离、穿刺头静脉成功后置入导引钢丝，经钢丝置入直鞘管，直鞘管内再置入1～2根导引钢丝，撤出直鞘管，分别经各个导引钢丝置入2～3个可撕开鞘管并插入起搏电极导线。结果：22例成功置入2或3个可撕开鞘管并插入电极导线，无血肿、血／气胸、误穿锁骨下动脉等血管并发症发生，3倒未能分离出头静脉，改为穿刺锁骨下静脉后置入电极成功。结论：新的穿刺方法及电极导线置入方法避免了常规穿刺锁骨下静脉各种相对严重的并发症；较常规头静脉切开、电极导线同时置入头静脉的方法，新方法使电极导线在各自鞘内操作更加准确、容易。但部分患者分离头静脉存在困难。

Objective：To introduce a new method for implanting pacemaker leads by puncturing the cephalic vein. Methods： Twenty-five patients who needed implantation of dual-chamber pacemakers or cardiac resynchronization therapy （CRT） were included in the present study. A guide wire and an introducer sheath were inserted successively after puncturing the cephalic vein. Another 1 or 2 guide wires were inserted into the introducer sheath and the introducer sheath was drawn back. Then 2 or 3 peel-away introducer sheaths were separately inserted via each guide wire, and the pacemaker leads were inserted into blood vessels and advanced into the heart. Results： Two or 3 peel-away introducer sheaths were successfully inserted into the blood vessels in 22 of the 25 patients, with no complications such as hematoma, pneumothorax, or subclavian artery puncture. We failed to isolate the cephalic veins in the other 3 patients and the patients were successfully converted to subclavian vein puncture. Conclusion： Our new method avoids the severe complications of traditional subclavian puncture. Compared with cephalic veins incision, our new method makes it easier and accurate for the pacemaker leads manipulation. But the cephalic veins are sometimes difficult to isolate.