心脏临时起搏支持严重心率缓慢患者的血液净化

Temporary cardiac pacing supports blood purification in patients with severe bradyarrhythmia

目的观察心脏临时起搏对严重心率缓慢患者血液净化的作用。方法7例因各种病因引起的急慢性肾功能衰竭患者伴严重心率缓慢时,经右颈内静脉、左锁骨下静脉途径穿刺置管行气囊电极床边紧急心脏临时起搏,支持血液净化。结果7例中5例行右颈内静脉置管,2例行左锁骨下静脉置管,起搏均成功,效果肯定,起搏时间2～16天,支持血液净化共32次,其中连续性静脉血液滤过(CVVH)2次,8例次行血液透析滤过(HDF),22例次行常规血透(HD),未发现心脏穿孔、气胸、血胸,1例发生导管感染。1例扩张型心肌病患者因低血压心力衰竭不能控制自动出院,其余6例均抢救成功。结论球囊电极床边心脏临时起搏,操作简便快捷,安全有效,可以提高严重心动过缓合并有肾功能不全的重危患者的抢救成功率。

Objective To investigate the effect of emergency bedside temporary cardiac pacing to support blood purification in patients with severe bradyarrhythmia. Methods Seven patients with severe bradyarrhythmia underwent temporary cardiac pacing supported blood purification with balloon-tipped electrode device via the right internal jugular vein, or left subclavian vein. Results Seven patients were successfully paced through the following veins：right internal jugular vein （ n = 5 ） ,left subclavicular vein （ n = 2）. The pacing-period of our series was 2 - 16 days . There was a total of 32 times of blood purification, including continuous venovenous hemofihration （CVVH） 2 times, hemodiafihration （HDF） 8 times, conventional hemodialysis （HD） 22 times . No heart perforation, pneumothorax, hemothorax occurred in these series. One patient developed catheter infection. One case of dilated cardiomyopathy patient with heart failure due to low blood pressure was automatically discharged and the remaining six patients were successfully treated. Conclusion Emergency bedside temporary cardiac pacing with ballon-tipped electrode is a safe and effective method for critically ill patients with severe bradycardia associated with renal failure and can raise their survival rate.