X线透视指导下猪心房间隔穿刺方法的探讨

R54Atrial septal puncture in swine guided by X-ray fluoroscopy

目的探讨X线透视指导下猪心房间隔穿刺的标准化流程和方法,提高房间隔穿刺的安全性和有效性。方法在X线透视指导下对48只浦东白猪进行房间隔穿刺,房间隔穿刺点的定位条件:(1)穿刺点高度为后前位透视下沿脊柱中线冠状静脉窦(CS)口上1个椎体高度;(2)以10°为间隔,按照右前斜10°~60°和左前斜10°~60°完成对CS导管的透视,可以判断CS 5-6和7-8电极的连线为垂直于卵圆窝的关系,确认CS 5-6和7-8电极在同一直线上的透视角度;(3)在此透视角度下,调整房间隔穿刺针及鞘管远段弧度消失呈直线状或接近直线状。结果成功对48只浦东白猪进行房间隔穿刺,无并发症发生,术后超声心动图证实房间隔有左向右分流,房间隔穿刺平均手术用时(25.7±11.5)min,平均X线曝光时间(14.0±3.4)min,平均辐射剂量(47.6±20.2)mGy。结论以CS电极为参考,X线透视指导下行猪心房间隔穿刺安全可靠。

Objective To explore the standardized process and method of atrial septum puncture(ASP)in swine guided by X-ray fluoroscopy and make ASP more safe and effective.Methods ASP was performed in 48 Pudong swines guided by X-ray fl uoroscopy.Three protocols for precise location of atrial septal puncture points were recommended.(1)Site of atrial septal puncture point in cranial-caudal direction was determined under posterior-anterior projection,which was confi ned to the cranial side of the coronary sinus(CS)orifi ce at a distance of 1 cone body height along the midline of spine.(2)With 10°intervals,the fl uoroscopy of the CS catheter was completed according to the right anterior oblique 10°~60°and the left anterior oblique 10°~60°,and the connection line of the CS 5-6 and 7-8 electrodes was perpendicular to the oval fossa,so as to confi rm the perspective angle of the CS 5-6 and 7-8 electrodes in the same straight line.(3)The arch feature of puncture needle and distal part of sheath turned into a straight line under the perspective angle,of which the CS 5-6 and 7-8 electrodes were in the same straight line.Results ASP was successfully performed in 48 Pudong swines without any complications.Echocardiography showed left to right shunt through atrial septum after ASP.5The average time of ASP was(25.7±11.5)minutes,the average X-ray exposure time is(14.0±3.4)min and the average radiation dose was(47.6±20.2)Gmy.Conclusions Using the coronal sinus electrode as a reference,atrial septal puncture in swine guided by X-ray fl uoroscopy was safe and reliable.