经左锁骨下静脉插入导管床边紧急心脏临时起搏25例

目的：报告经左锁骨下静脉穿刺插入带引导钢丝的电极导管行右心室起搏２５例经验。方法：经左锁骨下静脉插入导管，在心腔内心电图指引下判断电极到达右心室，将脉宽调至０．５ｍｓ测起搏阈值；将电压调至５Ｖ，频率６０～７０次／分恒定起搏。结果：开始穿刺至起搏成功３～８分钟（平均５．９分钟），起搏时间３～１６天。其中９例术后Ｘ线摄片、５例因植入永久心脏起搏器透视证实电极位于右心室心尖部。起搏期间１例伴急性左心衰竭，经调整电极后起搏良好，未再脱位；１例３束支传导阻滞合并室性逸搏心律患者，术后出现精神症状，经予脑细胞活化剂及多虑平３天后恢复正常；全部患者心电图均为完全性左束支阻滞图形，未出现心脏穿孔、血气胸等并发症，经治疗均痊愈出院。结论：本法创伤小，起搏电流低，患者无痛苦，能较长时间保持有效起搏；无需Ｘ线引导，易于推广急救应用

Catheterization through left subclavian vein:emergent bedside cardiac pacing in 25 patients

Objective:To introduce the experience of right ventricular pacing by inserting electrode catheter with steelwire inducer through left subclavian vein in 25 patients.Methods:The catheter was inserted through the left subclavian vein.Under the guidance of intra cardiac chamber ECG,the arrival of the electrode in the right ventricle was ensured.The pulse width was adjusted to 0.5 ms and the pacing threshold was tested,whereas the voltage was adjusted to 5V with the frequency being of 6070/min to stabilige the effect of pacing.Results:The time between the beginning of puncture and the successful pacing was 38 min with an average of 5.9 min.Pacing lasted for 316 days.Postoperative Xray films were taken in nine of the 25 patients.Permanent artificial pacemaker was implanted in five patients in whom the electrodes were proved fluoroscopically to locate in the right ventricular apexes.During the period of pacing,one patient developed acute left heart failure but no electrode displacement reoccurved after its readjustment.One patient who developed 3divison bundle branch block with ventri cular escape had postoperative psychiatric symptoms which disappeared after three days,treatment with brain cell activitor and doxepine. In all patients,the abnomal ECG change was complete left bundle branch block,no compliations such as cardiac perforation and hemopneumothorax were found.The patients were discharged after recovery. Conclusions:This method is a mildly invasive and painless procedure requiring only low electric current.Effective pacing can be maintained for a comparatively long time without radiologic guidance.Hence it is easy to popularize the procedure in emergency treatment.