优化的腋静脉穿刺技术在心血管植入型电子器械植入术中的应用

Optimized axillary vein puncture in cardiovascular implantable electronic device implantation

目的 观察优化的腋静脉穿刺技术在心血管植入型电子器械（cardiovascular implantable electronic device,CIED）植入术中应用的有效性和安全性.方法 入选2013年1月至2014年12月在中日友好医院行CIED植入术的患者220例,随机分为优化的腋静脉穿刺组（试验组）与常规锁骨下静脉穿刺组（对照组）.观察手术成功率及围术期并发症情况,分别于术后1、6、12个月及随后每12个月进行常规随访.结果 试验组和对照组穿刺成功率（96.6％对96.0％）、1次穿刺成功率（68.8％对69.3％）及术中X线曝光时间[（152.1±32.7）s对（145.6±46.1）s]相近,两组间差异无统计学意义.锁骨下静脉穿刺组术中出现导线操作困难2例,术后出现气胸2例,腋静脉穿刺组未见导线操作困难及气胸等情况.在随访中,试验组未发生导线挤压综合征,而对照组发生2例.试验组围术期及术后并发症发生率有降低趋势（1.82％对7.27％,P=0.11）.结论 优化的腋静脉穿刺技术的安全性和有效性可能优于传统锁骨下穿刺.

Objective To investigate the efficacy and safety of optimized axillary vein puncture for cardiovascular implantable electronic device （CIED） lead implantation.Methods Two hundred and twenty patients with indications of CIED implantation were randomized into optimized axillary vein puncture group （experimental group） or subclavian vein puncture group （control group）.The efficacy and safety of the two techniques were compared.Results The success rate （96.6％ vs.96.0％）,one-time success rate （68.8％ vs.69.3％） and X-ray exposure time[（152.1±32.7） s vs.（145.6±46.1） s]of axillary vein puncture and subclavian vein puncture were similar between the two groups.There were one case of pneumothorax and three cases of lead operating diff culties in subclavian vein puncture group.No complication occurred in axillary vein puncture group.In the follow-up,Electrode crash syndrome occurred in two patients in the control group.The incidence of complications showed a decreased tendency in the optimized axillary vein puncture group（1.82％ vs.7.27％,P=0.11）.Conclusion Optimized axillary venous approach may be superior to traditional subclavian vein approach for pacemaker lead placement.