头静脉途径心脏起搏器植入术中撕剥式导线导引器的应用价值

Application of Peel Away Introducer in Cardiac Pacemaker Implantation Through Cephalic Vein Approach

目的 探讨撕剥式导线导引器在经头静脉途径心脏起搏器植入术中的应用价值. 方法 183例经头静脉途径心脏起搏器植入术患者根据导线置入时是否应用撕剥式导线导引器分为改良组（n=91）和常规组（n=92）.比较两组手术时间、X线曝光时间、导线放置成功率、手术并发症. 结果改良组头静脉导线放置成功率97.80%.明显优于常规组80.43%（P〈0.01）.双腔起搏器植入者双导线放置成功率64.62%,明显优于常规组的26.56%（P〈0.01）.改良组手术时间、X线曝光时间分别为（61.13±12.03）min、（5.77±1.35）min.与常规组（62.22±13.26）min、（5.89±1.43）min相似（均P〉0.05）.两组各有1例术后囊袋血肿,随访3个月-2.5年未见其他并发症.结论 经头静脉途径植入心脏起搏器时,撕剥式导线导引器能明显提高导线放置成功率.

Objective To evaluate the value of a peel away introducer in pacemaker implantation via a cephalic vein approach. Methods 183 cases underwent cardiac pacemaker implantation through a cephalic vein. Of them, 91 cases （modified group） used and 92 cases （conventional group） did not use a peel away introducer. The procedure and fluoroscopy time, success rate of lead location and complications were analyzed. Results Pacing lead was successfully introduced in 97.8% of cases with a single chamber pacer and 64.62% with a double chamber pacer in modified group, which was significantly higher than that （80.40%, 26.56%, respectively） in conventional group （all P 〈 0. 01 ）. The procedure and fluoroscopy time was similar in modified group（ 61.13 ± 12.03 min, 5.77 ±1.35 min ） and conventional group （62.22 ± 13.26 min,5.89± 1.43 min ）. There was a pocket hematoma in each group. No other complication was found in both groups during 3 months to 2.5 years follow-up. Conclusion A peel away introducer may improve success rate of lead location during pacemaker implantation through a cephalic vein approach.