国人右房、右室导线实际使用长度的单中心统计分析

A single center analysis of the actual lengths of the right atrial and the right ventricular leads in Chinese people implanting pacemaker

目的测量国人植入起搏器时右房、右室导线的实际使用长度,为得出适合国人的起搏导线长度提供依据。方法连续入选117例植入起搏器患者,记录其性别、年龄、身高、起搏器类型、导线植入侧(左/右)、静脉植入路径(锁骨下静脉/头静脉)、电极放置的位置(心尖部/流出道)等参数。术中测量静脉入口结扎部位到脉冲发生器连接口处的导线长度,将电极导线总长度减去上述长度得出电极导线实际使用长度,术后通过胸部正位片测量导线进入上腔静脉后垂直下行的反向延长线同左、右锁骨中点连接线的交界点与左/右锁骨中点间距离的差值,得出对侧植入时所需导线的长度。结果左锁骨下路径植入时右房导线实际使用长度为(30.0±2.3)cm;右室导线实际使用长度为(39.1±3.0)cm。右锁骨下路径植入时右房导线实际使用长度为(26.5±2.8)cm;右室导线实际使用长度为(33.5±2.8)cm。Spearman′s单因素相关分析发现,右房导线实际使用长度主要与身高(r=0.475,P<0.001)相关,右室导线实际使用长度主要与身高(r=0.533,P<0.001)相关;结论相对于常规使用的心房心室导线长度(心房53cm/心室58cm),国人选择心房导线40cm/心室导线50cm应该是可行和更合理的。

Objective In this study, we measured the actual lengths of the right atrial and right ventricular leads in Chinese people implanting pacemaker and provided the data of suitable pacing leads lengths for Chinese people. Methods One hundred and seventeen consecutive patients with implantable pacemaker implantation were collected and recorded the parameters such as sex, age, height, Pacemaker type, lead implantation side （left / right）, vein approach （subclavian vein/ cephalic vein）etc. During the procedure, the length of the lead from the ligation site of venous entrance to the generator connector was measuered. The actual length of the lead was the subtraction between the total length of the lead and the measured length above. The distance in the X-ray film between the junction point （the reverse extension line of the lead into the superior vena cava and the left or right clavicle midpoint connecting lines） was measured and the left or right clavicle midpoint, the difference between which was the length of the required lead for contralateral implantation. Results When choosing left subclavian vein approach ,the actual length of the right atrial lead was（30.0±2.3）cm, the actual length of the right ventricular lead was（39.1±3. 0）cm. When choosing right subclavian vein approach ,the actual length of the right atrium lead was（26.5±2.8）cm, the actual length of the right ventricular lead was（33.5 ± 2. 8） cm. Spearman＇ s univiate correlation analysis showed that the actual length of the right atrial lead was significantly related to height（r=0. 475 ,P〈0. 001）,and the actual length of the right ventricular lead was also significantly related to height（r= 0. 533, P〈0. 001）. Conclusion The choice of the 40cm for atrial lead/ 50cm for ventricular lead in Chinese people should be feasible and reasonable comparing with the routine use of 53cm for atrial lead/58cm for ventricular lead.