经胸壁心内膜起搏穿刺点与冠状动脉行走位置的相关性

Correlation between the position coronary arteries and puncture sites for emergent transthoracic cardiac pacing

目的研究心前区经胸壁心内膜起搏穿刺点植入起搏钢丝损伤冠状动脉的概率。方法选择2015年6月至2016年6月于解放军第四一一医院就诊的100例冠状动脉造影患者,利用后前位冠状动脉造影动态影像,于心脏收缩期、舒张期测算心腔内穿刺点伤及冠状动脉的阳性率。结果于胸骨左缘第4肋间、胸骨左缘第5肋间、胸骨左缘左侧1 cm第4肋间、胸骨左缘左侧1 cm第5肋间、胸骨左缘左侧2 cm第4肋间和胸骨左缘左侧2 cm第5肋间穿刺点伤及冠状动脉前降支的概率分别为3%、3%、6%、11%、17%和7%,伤及右冠状动脉的概率均为零。结论心前区胸骨左缘第4或5肋间隙处穿刺右心室可作为经胸壁心内膜起搏法植入起搏钢丝首选的穿刺点。

Objective To investigate the probability of coronary artery injuries by implantation of pacing wire for emergent transthoracic cardiac pacing.Methods One hundred patients with coronary arteriography were chosen for the study. The possibilities of coronary artery injuries caused by different intracavitary puncture sites were assessed through the approach of posterior-anterior position coronary arteriography in systolic and diastolic phases.Results The posibilities of anterior descending coronary artery injuries caused by different intracavitary puncture sites of the fourth, the fifth, the lateral fourth intercostal 1 cm, the lateral fifth intercostal 1 cm, the lateral fourth intercostal 2 cm, or the lateral fifth intercostal 2 cm of the left border of sternum, for implanting pacing wire, were 3%, 3%, 6%, 11%, 17% and 7% respectively. The probabilities of right coronary artery injuries were all zero.Conclusion The fourth or fifth intercostal spaces of the left border of sternum could be the first choice puncture sites in the implantation of pacing wire for emergent transthoracic cardiac pacing.