床旁紧急临时心脏起搏262例分析

目的:评估床旁临时心脏起搏器安置术救治急危重患者心脏急症的可行性和有效性，分析不同静脉途径及电极导管的利弊。方法: 对262例伴发多种类型心律失常的患者在动态心电监测下采用床旁经静脉穿刺法行心脏临时起搏器安置术，入管路径依次为右侧颈内静脉136例次、双侧锁骨下静脉108例次、右侧股静脉18例次。评估临床可操作性、单次穿刺成功率、起搏成功率、术中及术后并发症等。结果: 254例次经床旁盲插导管成功起搏，成功率97.0%。4例在数字减影血管造影（DSA）引导下成功起搏，4例起搏失败。平均操作时间2～12 min。起搏器安置术中、起搏应用过程中共发生室速、血气胸、导管脱落、感知起搏不良等相关并发症27例，占10.3%。无室颤、心急穿孔等严重并发症。结论: 床旁临时心脏起搏术在心脏急危重患者特别是急性缓慢性心律失常的救治中具有快捷、损伤小、灵活性高、疗效好、并发症少等特点，特别是右侧颈内静脉路径及球囊漂浮起搏导管在危重症患者的综合救治中优势明显。

Analysis of temporary and urgent bedside heart pacemaker in 262 patients

AIM:To evaluate the safety and validity of temporary, bedside pacemaker implanted in critically ill patients with cardiac emergency and to compare the utility of different venous pathways and electrode catheter. METHODS: A total of 262 patients with different types of arrhythmia received temporary bedside pacemaker implantation via right internal jugular vein, bilateral subclavian vein or right femoral vein access during an emergency to evaluate the clinical operation, single puncture success rate, pacing success rate, and intra- and postoperative complications. RESULTS: In 262 patients, blind insertion catheter pacing at bedside was successfully done in 254 patients with a success rate of 96.95%. Four patients with DAS were successful and four cases were unsuccessful. Average surgical time was 2-12min. Twenty-seven cases were complicated by ventricular tachycardia, hemipneumothorax, ductal exfoliation, and pacemaker malfunctions in pacemaker implantation and application. There were 10.3% of cases without serious complications such as ventricular fibrillation or perforation. CONCLUSION: Temporary bedside pacemaker implantation used for severe arrhythmia is timely, safe and effective. Notable, the right internal jugular vein path and balloon floating pacing catheter has been shown to have obvious advantages in critically ill patients with comprehensive treatment.