经胸超声引导结合极少X线透视指导双腔起搏器植入术的研究

A study on the implantation of dual-chamber pacemakers guided by transthoracic ultrasound combined with minimal X-ray fluoroscopy guidance

目的探讨经胸超声引导下锁骨下静脉穿刺及结合极少X射线透视指导下完成双腔起搏器植入术的安全性和有效性。方法回顾性连续入选2019年1月至2020年1月住院拟行双腔起搏器植入的87例患者。按照是否应用超声引导下起搏器植入分为研究组(45例)和对照组(42例)。研究组在经胸超声引导下完成锁骨下静脉穿刺并经超声证实导丝进入下腔静脉,并在超声结合极少X线透视下完成起搏器电极植入。对照组在解剖定位下穿刺锁骨下静脉,X线确认导丝进入下腔静脉,并在X线指导下完成起搏器电极植入。比较两组间血管穿刺时间、手术时间、术中透视时间以及并发症发生情况。结果研究组的年龄明显高于对照组,体质指数明显低于对照组,差异均有统计学意义(均为P<0.05)。两组均完成起搏器植入术。与对照组相比,研究组完成两次锁骨下静脉穿刺的时间更短[(1.1±0.6)min比(3.2±1.7)min,t=7.786,P<0.001],放射剂量更少[(104.6±76.8)Gray比(617.3±347.2)Gray,t=9.660,P<0.001],术中透视时间更短[(43.8±14.6)s比(184.5±53.4)s,t=17.013,P<0.001]。对照组2例发生并发症,包括1例皮下血肿和1例少量气胸;而研究组未发生血肿及气胸等并发症,但两组间差异无统计学意义(χ^(2)=2.193,P=0.139)。结论超声引导下起搏器植入能够提高锁骨下静脉穿刺成功率,缩短穿刺时间,显著减少术中X线透视时间。

Objective To investigate the safety and effectiveness of transthoracic ultrasound-guided subclavian vein puncture and dual-chamber pacemaker implantation guided by minimal X-ray fluoroscopy.Methods A total of 87 patients scheduled for dual-chamber pacemaker implantation from January 2019 to January 2020 were consecutively enrolled.The patients were divided into a study group(45 cases)and a control group(42 cases)based on whether ultrasound guidance was used during pacemaker implantation.In the study group,subclavian vein puncture was performed under transthoracic echocardiography guidance,and the guidewire placement into the inferior vena cava was confirmed by ultrasound.Pacemaker electrode implantation was then performed under combined ultrasound and minimal X-ray fluoroscopy guidance.In the control group,subclavian vein puncture was performed under anatomical localization,and guidewire placement into the inferior vena cava was confirmed by X-ray.Pacemaker electrode implantation was performed under X-ray guidance.The vascular puncture time,operation time,intraoperative fluoroscopy time,and incidence of complications were compared between the two groups.Results The study group had a significantly higher age and lower body mass index compared to the control group,with statistical significance(both P<0.05).Pacemaker implantation was successfully completed in both groups.Compared to the control group,the study group had a shorter time for two subclavian vein punctures[(1.1±0.6)min vs.(3.2±1.7)min,t=7.786,P=0.001],lower radiation dose[(104.6±76.8)Gray vs.(617.3±347.2)Gray,t=9.660,P<0.001],and shorter intraoperative fluoroscopy time[(43.8±14.6)s vs.(184.5±53.4)s,t=17.013,P<0.001].Two complications occurred in the control group,including one case of subcutaneous hematoma and one case of pneumothorax.No complications such as hematoma or pneumothorax occurred in the study group,but there was no statistically significant difference between the two groups(χ^(2)=2.193,P=0.139).Conclusions Pacemaker implantation guided by ultrasound can improve the success rate of subclavian vein puncture,reduce puncture time,and significantly decrease intraoperative X-ray fluoroscopy time.