体表定位参考对侧斜位同侧造影的图像指导行腋静脉穿刺植入起搏器

Clinical application of body surface localization combined with contralateral oblique angiography to guide axillary venipuncture in pacemaker implantation

目的通过体表标识定位结合对侧斜位同侧造影的图像指导穿刺腋静脉,探讨一种更安全,成功率更高的穿刺技术。方法选择2018年2月至2020年2月本科室需行心脏起搏器植入患者,采用锁骨下距离胸三角尖部3 cm处结合对侧斜位30°同侧造影的图像指导穿刺腋静脉植入起搏电极导线,观察穿刺成功率,穿刺相关并发症。结果 67例患者,男性39例(58.2%),年龄(69.3±11.6)岁;单侧(左)穿刺成功率97%(65/67),总穿刺成功率100%。该技术体表标识:胸三角尖部。皮肤穿刺进针点:该点在锁骨下距离胸三角尖部3 cm处,该点与胸三角尖部连线大致平行于三角肌-胸大肌肌间沟(肌间沟)。造影角度对侧斜位(穿左侧采用右前斜位,反之亦然)30°。术中及术后无气胸、血胸、血肿等穿刺相关并发症。结论体表定位结合对侧斜位同侧造影的图像指导腋静脉穿刺技术是安全、有效的方法。

Objective To explore a safer and more successful technique of puncture of the axillary vein under the guidance of body surface identification and location combined with contralateral oblique angiography, and to analyze its effectiveness and safety in pacemaker implantation. Methods Sixty-seven cases of pacemaker implantation in our department from February 2018 to February 2020 were selected, and pacemaker electrode wires were inserted into the axillary vein under the guidance of contralateral oblique angiography and body surface markers and positioning, to observe the success rate of puncture and puncture related complications. Results Among the 67 patients, 39(58.2%) were male, and the age was(69.34±11.56) years old. The unilateral(left) puncture success rate was 97%(65/67), and the total puncture success rate was 100%. The body surface of the technique was identified as the apex of the thorax triangle. Skin puncture insertion point: this point was 3 cm below the clavicle from the apex of the thorax triangle, and the connection between this point and the apex of the thorax triangle was roughly parallel to the deltoid-pectoralis major intermuscular sulcus(intermuscular groove).Contrast angle: 30° in the contralateral oblique position(right anterior oblique position was adopted on the left side, and vice versa). There were no pneumothorax, hemothorax, hematoma and other puncture related complications during and after operation. Conclusion It is a safe and effective method to locate the body surface and guide the axillary venipuncture with contralateral oblique contrast.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(3):226-229]