超声心动图引导下安装临时心脏起搏器的应用

Clinical application of echocardiographic guidance in temporary cardiac pacemaker implantation

目的对比观察在超声心动图与放射线引导下安装临时心脏起搏器的效果和安全性。方法将需要安装临时心脏起搏器的50例患者按先后顺序分为两组,超声引导下安装临时心脏起搏器(超声组)25例,经右颈内或右锁骨下静脉插入起搏电极导管;放射线下安装临时心脏起搏器(放射组)25例,经股静脉插入起搏电极导管。结果两组临床特征相似,超声组从穿刺到开始起搏时间比放射组短,差异有统计学意义[(521±180)s vs.(750±226)s,P<0.001]。超声组重置电极导管患者比例明显少于放射组,差异有统计学意义[8%(2/25)vs.40%(10/25),P<0.001]。超声组起搏功能失常的发生率低于放射组,差异有统计学意义[8%(2/25)vs.32%(8/25),P=0.001]。超声组未发生心脏穿孔和起搏导管周围静脉血栓,放射组分别发生1例和2例。结论在超声心动图引导下安装临时心脏起搏器操作方法简便、安全、有效,是一种较好的方法,可准确放置起搏电极导管。

Objectives To investigate and compare the procedural skill and efficacy of echocardiographic guidance and X-ray guidance in temporary cardiac pacemaker implantation.Methods Temporary cardiac pacing was performed in 50 patients from echocardiography group and X-ray group （n=25 respectively,divided according to the guidance modality）.Pacemaker electrode catheters were implanted via right internal jugular vein or right subclavian vein under echocardiographic guidance in echocardiography group and via femoral vein guided by X-ray in X-ray group.Results Temporary cardiac pacemaker implantation was successfully performed in all the patients.The procedure duration of echocardiography group was significantly shorter than that of X-ray group [（521±180） s vs.（750±226） s,P〈0.001].Incidence of reimplantation in echocardiography group was obviously lower than that in X-ray group [8% （2/25）vs.40% （10/25）,P〈0.001].Incidence of pacing system malfunction in echocardiography group was significantly lower than that in X-ray group [8% （2/25） vs.32% （8/25）,P=0.001].Cardiac perforation and phlebothrombosis around pacing catheter did not occur in echocardiography group,while 1 and 2 cases occurred in X-ray group,respectively.Reimplantation and complication occurred less in echocardiography group.Conclusions Temporary cardiac pacemaker implantation under echocardi-ographic guidance is effective,safe and convenient.