床旁临时心脏起搏256例的疗效与方法学研究

Study on the clinical efficacy and methodology of bedside temporary cardiac pacing in 256 cases

目的探讨床旁临时心脏起搏的疗效和方法学。方法连续收集2020年1月-2023年5月曲靖市第一人民医院256例患者接受床旁临时心脏起搏的相关信息,分析治疗效果、相关费用、结局转归、并发症和技术细节。结果256例床旁临时起搏成功率99.6%,1例患者床旁操作不成功,转导管室透视下操作起搏。静脉穿刺成功到心室起搏耗时平均(7.9±4.8)min。256例床旁临时心脏起搏患者的平均总治疗费用(39246±5100)元,临时起搏相关平均费用(2710±320)元,占总费用6.9%。改行永久起搏的118例患者中,居民医保/新农合25例(21.2%)、职工医保93例(78.8%);拒绝永久起搏的20例患者中,居民医保/新农合13例(65.0%),职工医保7例(35.0%)。右室心尖部起搏157例与右室流出道起搏99例的感知故障发生率无显著性差异(10.8%VS 11.1%,P>0.05)。结论训练高效敏捷的应急团队,在体表心电图指导下首选锁骨下静脉穿刺植入漂浮电极实施床旁临时心脏起搏,有效、安全、简便、快速、经济,应成为基层医院抢救致命性缓慢性心律失常最基本的常规手段。

Objective To explore the efficacy and methodology of bedside temporary cardiac pacing.Methods The relevant information of 256 patients receiving temporary bedside cardiac pacing in Qujing Municipal First People s Hospital from January 2020 to May 2023 was continuously collected,and the treatment effects,related costs,outcomes,complications and technical details were analyzed.Results The success rate of temporary bedside pacing in 256 patients was 99.6%,while in one patient,the bedside procedure was unsuccessful,and pacing was performed under the guidance of catheter room fluoroscopy.The average time from successful venous puncture to ventricular pacing was 7.9±4.8 minutes.The average total treatment cost of 256 patients with bedside temporary cardiac pacing was 39246±5100 yuan,and the average cost related to temporary pacing was 2710±320 yuan,accounting for 6.9%of the total cost.Among the 118 patients who underwent permanent pacing,25(21.2%)were covered by resident medical insurance/new rural cooperative medical insurance,and 93(78.8%)were covered by employee medical insurance;Among the 20 patients who refused permanent pacing,13(65.0%)were covered by resident medical insurance/new rural cooperative medical insurance,and 7(35.0%)were covered by employee medical insurance.There was no significant difference in the incidence of perceived failure between 157 cases of right ventricular apex pacing and 99 cases of right ventricular outflow tract pacing(10.8%VS 11.1%,P>0.05).Conclusions It is effective,safe,simple,rapid and economical to train an efficient and agile emergency team and implement temporary bedside cardiac pacing by subclavian vein puncture with floating electrode under the guidance of body surface electrocardiogram,which should be the most basic routine method for rescuing fatal chronic arrhythmias in primary hospitals.