气囊电极床边紧急心脏临时起搏的临床观察

总结 36例经右颈内静脉、左锁骨下静脉及右股静脉三种不同的途径穿刺插管 ,行气囊电极床边紧急心脏临时起搏的经验。按Seldiger方法行静脉穿刺置管 ,按Swan Ganz球囊导管操作方法推送气囊电极导管 ,在无X线透视条件下 ,根据心腔内心电图、室性早搏出现或体表起搏心电图判断电极进入右室 ,行右室心内膜临时起搏。结果 :36例全获成功 ,其中右颈内静脉 (中位法 ) 16例、左锁骨下静脉 (下位法 ) 12例、右股静脉 8例。前两者开始穿刺至起搏成功时间为 3～ 10min ,后者为 10～ 2 5min。起搏效果肯定 ,起搏时间 2～ 2 0天。经股静脉插管者 2例误入下腔静脉分支 ,1例导管扭曲受阻 ,此 3例重新插管起搏成功。经左锁骨下静脉插管 1例误入左颈内静脉 ,改右颈内静脉起搏成功。全组除 11例腔内心电图和 5例边起搏边送管方法确定导管头位置外 ,余 2 0例在边送管边观察室性早搏出现的方法判断电极进入右室。术后胸片证实导管头位置与体表起搏图形定位的部位完全一致。除 3例电极移位和 2例短阵室性心动过速外 ,全部病例未发生心脏穿孔、气胸、血胸及感染等并发症 ,除 2例死于原发病外 ,余均痊愈出院。结论 :本法创伤小、方便快速、安全有效、无需X线引导 ,值得急救推广应用

Experince of Installation of Emergency Bedside Temporary Cardiac Pacemaker in Patients with Serious Cardiac Arrhythmia

To present the result of installation of bedside emergency temporary cardiac pacing with balloontipped electrode device via the right jurgular,left subclavian,or right femoral vein.ThirtySix patients with serious arrhythmia underwent to install the temporary pace maker.Using Seldinger and SwanGanz proceduces,a ballontipped floatdirected pacing electrode was introduced into the right ventricle,The cardiac pacing was monitored by means of intracardiac electrographic device,provoked ventricular premature beats and superficial pacing electrography.Conventional chest xray films were taken for control.Results:All patients were successfully paced.The routes of insertion of the electrode were through the folowing veins:Right jungular vein cannula (n=16),left subclavicular vein (n=12) and right femoral vein in 8 cases.The overall operation duration (from puncturing to successfully pacing) was 3～10 minutes through the jugular or subclavian vein and 10～25 minutes in femoral vein,All of those problems were solved by manual manipulation with no difficuty.The pace maker electrode position and cardiac pacing was monitored by means of intracardiac electrography in 11 cases,superficial pacing electrography in 5 cases and provoked ventricular premature systoles in 20 cases.No complication or adverse reaction was occurred in this series.The pacing periods of our series were from 2～20 days.Conclusion:Emergency bedside temporary cardiac pacing with balltipped electrode is a safe and effective method in patients with serious cardiac arrhythmia.Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(2):110～112] Cardiac pacing,temporary Balloontipped electrode Emergency management