床旁心脏临时起搏的临床应用

近年来随着介入医学的普及和提高 ,越来越多的临床医生可以在Ｘ线指引下熟练地安置心脏临时起搏器。但在实际临床工作中 ,相当多的病人由于疾病危重或条件所限 ,要求必须迅速在床旁进行心脏临时起搏。简单而适用的方法是应用漂浮电极导管在床旁植入。应用漂浮电极导管进行床旁心脏临时起搏于 1973年首先由Ｓｃｈｎｉｔｚｌｅｒ等报道 ,并使此项技术在国外迅速得到推广应用 ,并已成为医院急诊抢救必不可少的医疗技术之一 ,挽救了许多病人的生命。二十世纪八十年代ＲｏｂｅｒｔｏＬａｎｇ等对此项技术进行了更深入的研究 ,并与Ｘ线指导下植入…     

腔内心电图指导床旁紧急临时起搏

目的：了解腔内心电图在指导床旁紧急临时起搏器械安装的成功率。方法：根据不同部位腔内心电图形特点，指导床旁经静脉紧急临时起搏器安装。结果：23例患者中3例失败，1例为右房起搏，19例右室起搏，成功率为86.96％，术中12例出现室性早搏，术后3例患者出现电极脱位。结论：腔内心电图指导床旁紧急临时起搏成功率高，为抢救危重患者争取了时间。     

床旁应用普通电极导管经右颈内静脉紧急心脏临时起搏54例

2002年7月至2004年2月，作对54例住院或急诊患因不宜搬动或病情危急，在床旁采用普通临时起搏电极，经右颈内静脉紧急临时心脏起搏54例，报道如下。     

腔内心电图指导床旁紧急临时起搏

近年来，我们对23例缓慢性心律失常患者采用腔内心电图指导和床旁无X线透视情况下，紧急安装了临时起搏器。     

紧急床旁心脏临时起搏68例体会

目的总结床旁行临时心脏起搏治疗的相关操作技巧,以提高成功率。方法对68例急诊床旁行临时起搏器治疗患者,首先根据患者血流动力学情况选择最熟练、准确、快捷的血管途径进行,可选择左或右锁骨下静脉。电极到位操作时要选择合适的起搏电极。可＂带电操作＂,以便根据心电图结果判断电极位置。调整起搏参数,注意并发症的发生。结果血管入路：经左锁骨下静脉36例、右颈内静脉18例、右股静脉13例、右锁骨下静脉2例。68例起搏均获成功,从深静脉穿刺到成功起搏时间为（8.0±3.5）（5～13）min。其中1例穿刺针误穿刺入锁骨下动脉,拔除并压迫10 min后生命体征平稳,重新穿刺成功;5例出现室性心动过速,适当撤出起搏电极后即自行终止;1例出现室颤,立即给予电除颤。8例11次出现间断起搏、感知不良,经调整位置后恢复正常。结论掌握床旁临时心脏起搏治疗的相关操作技巧,可以帮助提高紧急床旁临时心脏起搏治疗的成功率。     

气囊漂浮电极床旁紧急心脏临时起搏的临床应用——附136例报告

目的：总结经、左、右锁骨下静脉穿刺插管，用气囊漂浮电极床旁紧急心脏过缓性心律失常的经验。方法：回顾性分析因不同病因所致严重心动过缓性心律失常并进行紧急心脏临时起搏治疗的136例患者的临床资料，按深静脉穿刺置管法（Seldiger法）行深静脉穿刺，并按漂浮导管置入法（Swan-Ganz导管操作方法）推送气囊电极导管，在床旁无X线透视条件下，根据心腔内心电图，室性期前收缩出现或体表起搏心电图判断电极是否进入右心室，行右心室心内膜临时起搏。结果：130例（96％）起搏成功，开始穿刺至起搏成功时间为3－30分钟，起效果肯定，起搏时间1－31日，3例电极无法到位转导管室X线透视下放置电极导管，3例电极到位后不能夺获右心室，电极脱位6例，经重新安置电极后恢复起搏。穿刺损伤胸淋巴管1例，结论：床旁气囊漂浮电极紧急心脏起搏创伤小，方便快速，安全有效，值得在急救中推广应用。     

用漂浮起搏电极紧急床旁安置心脏临时起搏器的护理

经静脉植入临时心脏起搏器是抢救心脏停搏或严重缓慢心律失常的重要治疗方法。大多采用经股静脉或锁骨下静脉在X线透视下放置电极导管或经床旁盲插。漂浮电极导管的应用，为床旁准确植入电极，缩短手术时间提供了可能。我院自2002年8月-2005年8月应用漂浮起搏电极行床旁临时起搏．抢救严重缓慢心律失常患者24例．均取得满意效果，获得了一些宝贵的护理经验，现将护理体会介绍如下。     

紧急床旁临时心脏起搏在危重病人抢救中的应用

我院2002年6月~2005年10月对急诊科和住院部具有潜在或已经心跳骤停的36例危重病人,采用经深静脉紧急临时心脏起搏术进行抢救。1资料与方法1.1临床资料36例患者,男21例,女15例,年龄13~84岁。其中急诊科呼吸心跳骤停患者12例,外科病人合并有严重心动过缓需术中保护患者11例,心内科患者13例。1.2方法采用美国ARROW公司生产的5Fr100 cm双极球囊飘浮临时起搏电极导管,术前检查球囊充气后是否膨胀良好,有无漏气或不膨胀。如果良好,排除气体,锁住充气注射器后,选择深静脉(颈内静脉、锁骨下静脉、股静脉),以Seldinger法穿刺,置入球囊导管,估计导…     

床边应用球囊漂浮电极导管临时心脏起搏的临床观察

目的:探讨床边漂浮电极导管临时心脏起搏的可行性及疗效。方法:对应用球囊漂浮电极导管行床边临时心脏起搏的98例进行总结分析。结果:98例患者床边临时起搏均成功。无感染、无血栓形成或栓塞、无气胸、无静脉炎、无心脏穿孔等并发症。结论:在体表心电图和导管深度指导下,应用球囊漂浮电极导管进行床边临时心脏起搏是一种简单、快捷、安全有效、实用的起搏方法,对挽救生命,提高抢救成功率有积极作用,易于在基层医院推广应用。     

经锁骨下静脉床旁紧急心脏临时起搏12例分析

目的:总结经左锁骨下静脉插入导管床边紧急心脏临时起搏在急诊抢救中的应用。方法:12例阿-斯综合征、心脏骤停患者在急诊床边经锁骨下静脉插入带指引钢丝临时起搏导管,应用AXQ-3体外起搏器,边起搏边推送电极导管,紧急心脏起搏。结果:12例均起搏成功,达到有效起搏时间为3～9分钟,效果恒定、可靠。结论:该法起效快,疗效肯定,急诊应用,可缩短有效起搏时间,使更多危重者获救。     

床旁临时心脏起搏术在严重缓慢性心律失常患者抢救中的价值

目的探讨床旁临时心脏起搏术在抢救急诊科严重缓慢性心律失常患者中的临床应用价值。方法选取2013年8月~2014年8月我院急诊科的严重缓慢型心律失常患者22例作为观察组,同期选取住院的23例在DSA引导下安装临时心脏起搏器的患者作为对照组。观察组给予床旁安装心脏起搏器。观察比较两组心脏起搏器的安装时间、一次起搏成功率、一次点击未到率,术后观察比较两组的并发症情况及临床疗效。结果观察组床边临时心脏起搏器的安装时间明显要短于对照组,差异高度有统计学意义(P<0.01);一次起搏成功率、一次点击未到位与对照组比较,差异均无统计学意义(P>0.05)。观察组术区血肿、心律失常、电极脱位、导管相关性感染、起搏器综合征等并发症的发生率与对照组比较,差异均无统计学意义(P>0.05)。观察组自身窦性心律恢复率、术后1周后自身窦性心律恢复率以及死亡率与对照组比较,差异均无统计学意义(P>0.05)。结论床旁临时心脏起搏在急诊科抢救严重缓慢性心律失常患者中是一项简单而适用的方法,其安全性好,操作方便,并发症少,疗效可,值得推广应用。     

体外无创临时心脏起搏抢救急诊病人34例

体外无创临时心脏起搏抢救急诊病人３４例ＥｘｔｒａｃｏｒｐｏｒｅａｌＮｏｎｉｎｖａｓｉｖｅＴｅｍｐｏｒａｒｙＣａｒｄｉａｃＰａｃｉｎｇｆｏｒＲｅｓｃｕｉｎｇ３４ＥｍｅｒｇｅｎｃｙＰａｔｉｅｎｔｓ李玫ＬｉＭｅｉ（ＦｉｒｓｔＡｆｉｌｉａｔｅｄＨｏｓｐｉｔ...     

The Use of the Balloon-Tipped Floating Catheter in Temporary Transvenous Cardiac Pacing

The effectiveness and safety of balloon-tipped, flow guided, electrodes for ventricular pacing as opposed to the fluoroscopy-guided semi-rigid bipolar electrodes have never been compared in a controlled study. A prospective study was therefore undertaken to compare both techniques in semi-elective and emergency procedures. Flow guided electrodes were inserted in 67 patients (group A) and semi-rigid electrodes in 44 patients (group B). The results of group A were judged to be superior to those of group B in four aspects: a) shorter time (6'45" vs. 13'30", p less than 0.0005); b) lower incidence of catheter displacement (13.4 vs. 32.0 percent, p less than 0.05); c) longer interval of time between implantation and catheter displacement (4.4 vs. 1.9 days, p less than 0.0005); d) lower incidence of serious ventricular arrhythmias during insertion (1.5 vs. 20.4 percent, p less than 0.005). Threshold at insertion was not significantly different (0.6 +/- 0.3 vs 0.7 +/- 0.2 milliampere). The superiority of flow-guided electrodes over fluoroscopy-guided electrodes persisted in the comparison of semielective insertions in groups A and B. We conclude that the flow-guided insertion technique is safer, more expeditious and more stable than the fluoroscopy-guided technique in semi-elective as well as in emergency insertions.     

Lead Dislodgment of a Permanent Pacemaker Due to Removal of a Temporary Pacing Electrode

A 63-year-old male received a transvenous temporary pacemaker for bradyarrhythmia following mitral valve replacement and tricuspid valve annuloplasty. A transvenous permanent pacemaker was implanted the following day due to persistence of the bradyarrythmia and pacemaker dependency of the patient. Later the same day during removal of the temporary pacing electrode the permanent pacing lead was dislodged and had to be operatively repositioned. To avoid this complication, the position of pacemaker leads should be checked postoperatively with a frontal and lateral chest radiograph, and fluoroscopy should be used during removal of a temporary lead.     

Intermittent Pacemaker Syndrome: Revision of VVI Pacemaker to a New Cardiac Pacing Mode for Tachy-Brady Syndrome

A patient with tachy-brady syndrome manifested by paroxysmal atrial fibrillation and symptomatic sinus bradycardia and treated by VVI pacing developed pacemaker syndrome during episodes of ventricular pacing. His cardiac pacemaker was revised to a dual chamber system utilizing the new AV sequential DDI pacing mode which eliminated pacemaker-related tachycardias and totally abolished the pacemaker syndrome symptoms. There have been no further episodes of atrial fibrillation, possibly due to elimination of temporal dispersion of refractory periods during bradycardia. The propensity for atrial fibrillation has also been minimized by excluding competitive atrial stimulation during DVI pacing. The DDI mode provides the clinician increased utility and flexibility in the use of AV sequential pacing therapy.     

Torsades de Pointes: A Rare Complication of Temporary Pacing for Permanent Ventricular Pacemaker Failure

Torsades de pointes, a distinctive type of polymorphous ventricular tachycardia, may be induced by critically timed ventricular stimulation during electrophysiologic studies or, rarely, in patients with temporary or permanent ventricular pacemakers. The following case illustrates how, when temporary ventricular pacing is instituted to maintain heart rate in a patient with a defective permanent ventricular pacemaker, this potentially fatal arrhythmia may occur as a complication of interaction between the two pacemakers.     

Electrophysiological and Clinical Comparison of Two Temporary Pacing Leads Following Cardiac Surgery

Temporary pacing leads are invaluable in diagnosis and treatment of arrhythmia after cardiac surgery. The ideal lead possesses reliable pacing and sensing capabilities throughout the postoperative period. Ease of handling and a low complication rate are essential. This study compares a new lead (Medtronic model #6492) to a temporary pacemaker lead established in clinical use (Medtronic model #6500). One lead of each type was placed in the right atrium and ventricle in 33 patients undergoing elective coronary revascularization. Pacing function was measured on the first and fourth postoperative days. Lead complications were documented. On day 1, there was no statistical difference between lead types in terms of pacing (voltage threshold, current threshold), impedance, or sensing (P wave amplitude, R wave amplitude). On day 4, both leads showed an increase in pacing threshold and a decrease in sensing ability. The only statistical difference between lead types was in atrial sensing on day 4, as measured by the P wave amplitudes (1.95 +/- 0.18 V for model 6492 vs 1.40 +/- 0.14 V for model 6500, P < 0.05). Two leads of each model failed to pace in the ventricular position and one lead in each model in the atrial position. There were no complications attributable to either pacemaker lead. We found that both lead types were reliable and functioned well. The Medtronic Model #6492 lead demonstrated better long-term sensing, although in this study the difference was not clinically significant.