床边紧急心脏起搏在急诊急救中的应用价值

The value and feasibility of temporary bedside cardiac pacing in the emergency treatment of severe bradycardia

目的 探讨床边紧急漂浮临时心脏起搏在急诊抢救中的应用价值及优越性。方法回顾性分析内蒙古医学院第一附属医院近4年床边紧急漂浮临时心脏起搏130例和70例X线指导下临时心脏起搏抢救各种病因引起严重的缓慢型心律失常患者。结果130例床边紧急漂浮临时心脏起搏患者成功起搏127例（97．69％），电极未到位3例（2．31％），电极脱位3例（2．36％），无严重并发症发生。从就诊到操作开始的时间为5—15min，穿刺到成功起搏的时间为（4±2．5）min；70例X线指导下临时心脏起搏患者成功70例（100％），脱位6例（8．57％），下肢静脉血栓1例（1．43％），心肌穿孔致心包填塞2例（2．86％），从就诊到操作开始的时间为30～90min，穿刺到成功起搏的时间平均为（3．5±1．5）min。结论应用床边紧急漂浮临时心脏起搏救治严重缓慢型心律失常方法简便、并发症少，是一种及时、安全、有效的抢救措施，可在急诊急救中推广应用。

Objective To study the value and feasibility of temporary emergency bedside cardiac pacing. Method Two hundred patients with severe witnessed bradycardia were treated with temporary emergency cardiac pacing. We treated 130 patients with emergency bedside pacing and 70 patients with x-ray-guided pacing. Results Emergency bedside pacing was successful in 127 patients except three patients and no postoperative complications occurred. X-ray-guided pacing was successful in all 70 patients but three patients experienced complications： one deep venous thrombosis and two cardiac tamponades due to myocardial perforation. The pacing electrodes were more likely to be displaced in X-ray-guided pacing than in emergency bedside pacing （six cases versus three cases）. The door-to-operation time was 30 - 90 min for x-ray-guided cardiac pacing and 5 - 15 min for emergency bedside pacing. Needle-to-pacing times were similar for both procedures （3.5 ±1.5 min for x-ray guided pacing versus 4 ±2.5 min for bedside pacing）. Conclusions Temporary emergency bedside cardiac pacing is a rapid, efficient and safe procedure for treating severe witnessed bradycardia. The technique is easily mastered and may prove lifesaving in an emergency.