完全性心脏传导阻滞:一种罕见的中心静脉置管并发症

Complete heart block: A rare central venous catheter placement complication

中心静脉置管是一项快速、安全、有效建立深静脉通路,以抢救危重患者,特别是血液透析患者的手术。中心静脉置管的并发症很少见,但也有出血、感染、栓塞、低血流量、心律失常等并发症报道。本例患者有左束支传导阻滞,在中心静脉置管时出现了右束支传导阻滞,导致完全性心脏传导阻滞,立即予以异丙肾上腺素治疗并尽快结束手术。经过治疗后,患者恢复窦性心律。此并发症相对罕见且较严重,需要临床医生尽早意识到危险性并尽快处理。患者发生完全性心脏传导阻滞可能与导管或导丝对右心室的机械性损伤有关,因此,中心静脉置管时应特别小心,且导丝及导管插入深度应小于18 cm。

Central venous catheter(CVC)placement is an operation which can establish a fast,safe,and effective deep venous access to rescue patients under critical conditions,especially for those receiving hemodialysis.It is a simple operation with almost no complications,but different complications have been still reported,such as bleeding,infection,embolism,low blood flow,and cardiac arrhythmias.In this case,the patient with preexisting left bundle branch block suffered right bundle branch block,leading to complete heart block during CVC placement.When the patient developed complete heart block,we immediately treated him with isoproterenol,and the surgery was terminated as soon as possible.The patient gradually recovered the sinus rhythm after the treatment.This complication is rare but severe,and clinicians should recognize the risks and take strategies as early as possible.We think the cause of complete heart block in this patient may be related to mechanical trauma to the right ventricle by the guide wire or catheter insertion.Therefore,CVC placement should be performed with more caution,and the guide wire and catheter tip should be inserted less than 18 cm deep.