经皮胸壁心脏起搏的临床应用价值

为探讨经皮胸壁心脏起搏紧急抢救心脏停搏的临床价值 ,对 30例心脏停搏患者于床边迅速粘贴经皮胸壁心脏起搏专用电极 ,应用美国惠普公司CodeMasterXL+ 心脏监护除颤起搏仪紧急起搏 ,其他复苏措施积极实施。结果 :起搏成功 2 1例 ,临床有效 16例 ,复苏成功 14例。达起搏成功所需时间为 1.6± 0 .4 (1.0～ 5 .0 )min ,持续稳定地起搏总时间为 80 .0± 32 .6 (8～ 12 0 )min ,有效起搏电流强度为 6 5± 12 .3(5 0～ 130 )mA ,有 7例过渡至X线下经静脉心内膜起搏。起搏成功的心电图表现为起搏心律且其QRS波于监护Ⅱ导联呈主波向下的综合波 ,融合波或 /和较快的自主心律。起搏电流强度大小并不影响对起搏成功的QRS波的判断。起搏过程中均有胸壁肌肉抽动 ,5例局部疼痛者仅 1例需用镇静剂 ,无其他并发症。结论 :经皮胸壁心脏起搏操作简便快速 ,疗效可靠且无创安全 ,病人耐受性良好 ,是紧急抢救心脏停搏行之有效的方法。

Clinical Practice of Percutaneous Transthoracic Cardiac Pacing.

To investigate the clinical practice and effects of emergent percutaneous transthoracic cardiac pacing in treating cardiac arrest.Percutaneous transthoracic cardiac pacing electrodes were attached immediately to the cardiac arrest patient at bedside and the defibrillation monitor(HP Code Master XL + U.S.A)was applied to rescue the patients.Pacing was successful on 21 of 30 cases with a pacing duration of 1.6±0.4(1.0～5.0)minutes and continuous and steady pacing duration of 80±32.6(8～120)minutes.Pacing was clinically effective on 16 cases.Resuscitation was successful on 14 cases.Effective pacing current intensity was 65±12.3(50～130)mA.Transvenous endocardial pacing under X ray was applied subsequently on 7 cases.Thoracic walls of all patients were twitching during pacing(with tolerable topoalgia in 4 cases).Sedative was applied only in one patient with evident topoalgia.Successful pacing on ECG shows 1:the pacing rhythm of heart with a downward main wave among QRS complex waves emerging on lead Ⅱ;2.The blended waves or/and a faster autonomic rhythm.The current intensity of pacing does not affect the evaluation of successful pacing QRS waves.Conclusion:Percutaneous transthoracic cardiac pacing is suitable and efficient for rescuing cardiac arrest patients.The effect is reliable,rapid,safe and non trauma.Tolerance of the patients are fine.