锁骨下静脉穿刺与头静脉切开途径安置心脏起搏器的随机对照研究

Prospective Randomized Comparison of Pacemaker Implantation Using the Subclavian Vein Puncture Versus the Cephalic Vein Cutdown Approach

为比较锁骨下静脉穿刺与头静脉切开途径安置心脏起搏器的价值 ,将 1 0 0例需安置心脏起搏器的病人随机分为锁骨下静脉穿刺组和头静脉切开组 (均包括单腔亚组和双腔亚组 ) ,每组各 5 0例。观察两种手术径路安置起搏器的手术时间、X线曝光时间、手术并发症及病人对手术切口及囊袋的满意度。结果 :无论是手术时间 ,还是X线曝光时间 ,锁骨下静脉组中单腔亚组及双腔亚组均比头静脉组中的对应亚组为短 ( 64.1± 1 4.2minvs 73.8± 1 1 .6min ,86.4± 1 3.2minvs 1 0 6.5± 1 9.4min和 3.45± 0 .83minvs 4.5 1± 2 .2 7min ,5 .5 9± 0 .78minvs 8.2 7± 4.91min ,P均 <0 .0 5 )。锁骨下静脉穿刺组心室电极导线放置成功率为 1 0 0 % ,而头静脉切开组则为 5 6% ,二者亦有显著性差异 (P <0 .0 5 )。而两组并发症发生率无差异。病人对切口及囊袋满意程度的积分 ,锁骨下静脉组明显高于头静脉组 ( 2 .2 4± 0 .5 6vs 1 .92± 0 .5 7,P <0 .0 1 )。结论 :只要锁骨下静脉穿刺技术熟练 。

To compare the value of pacemaker implantation using the subclavian vein(SCV) puncture and the cephalic vein(CV) cutdown approach, 100 patients were randomized into SCV group and CV group, their procedure time and fluoroscopy time as well as complications were observed. The scores of incision and pocket were obtained by the questionnaire. Results: The procedure time and fluoroscopy time of the single chamber subgroup and dual chamber subgroup in SCV group were significantly less than those in CV group(64.1±14.2 min vs 73.8±11.6 min, 86.4±13.2 min vs 106.5±19.4 min and 3.45±0.83 min vs 4.51±2.27 min, 5.59±0.78 min vs 8.27±4.91 min,all P <0.05). The success rate of ventricular lead insertion in SCV group was higher than that in CV group(100% vs 56%, P <0.05).The complications were not significant between the two groups. The scores of incision and pocket given by the patients in SCV group were higher than those in CV group( 2.24±0.56 vs 1.92±0.57, P <0.01). Conculusion:So long as the physician has skillful SCV puncture technique, the SCV approach should be considered a preferable access in pacemaker implantation .