起搏心电图引导经左锁骨下静脉床边临时心脏起搏的临床分析

目的探讨起搏心电图引导经左锁骨下静脉途径行紧急床边临时心脏起搏技术的可行性及安全性。方法以seldinger法穿刺左锁骨下静脉置入鞘管，从鞘管推送电极至心电监护出现室性早搏或短阵室性心动过速，然后连接临时心脏起搏器，并设置起搏频率超过患者自主心率20次／min，输出电压为3～5V，感知灵敏度为2mV。起搏器完全起搏后，记录12导联心电图，并根据Ⅱ、Ⅲ、avF导联起搏QRS图形调整电极位置，直至Ⅱ、Ⅲ、aVF导联起搏QRS主波向下，V1-V6导联起搏QRS呈完全性左束支阻滞图形。结果8例患者获良好的起搏效果，全部一次插管成功，操作时间5～10min，插管深25～30cm。无手术相关并发症。结论由起搏心电图引导，经左锁骨下静脉行紧急床边临时心脏起搏是一种安全、有效、可行的方法，成功率高，值得推广应用。

Bedside temporary cardiac pacing via left subclavian vein guided by pacemaker electrocardiogram

Objective To investigate the feasibility and safety of bedside temporary cardiac pacing via left subclavian vein guided by pacemaker electrocardiogram. Methods Punctured the left subclavian vein by seldinger＇s method, then the sheath was sent into the left subclavian vein. The temporary cardiac pacing electrode was sent into chambers of heart through the sheath until appearing ventricular premature beats or short paroxysmal ventricular tachycardia. Connected the pacing electrode to the temporary cardiac pacemaker, the pacing rate, output voltage and sensitivity were set up 20bpm over the self heart rate, 3-5V and 2mV respectively. The 12- leads pacemaker electrocardiogram was recorded after complete pacing and the site of the pacing electrode was adjusted according to the QRS configuration of Ⅱ、 Ⅲ、 aVF leads until the dominant wave of QRS inversed. And QRS configuration of V1 - V6 leads presented complete left bundle branch block. Results The pacing electrodes were inserted successfully in all of the patients, and all of them obtained satisfactory pacing effect, the operating time was 5- l0 mins, the depth of the inserted electrodes was 25-30 cm, there were no operating related complications appeared. Conclusion Temporary cardiac pacing via left subclavian vein guided by pacemaker electrocardiogram was a sort of safe, effective and feasible approach, the achievement ratio of which was high and was worth to applied widely in the clinical practice.