锁骨下静脉途径心脏起搏器置入术中撕剥式电极导线导引器的应用

目的探讨撕剥式电极导线导引器在经锁骨下静脉途径行永久性心脏起搏器置入术中的应用价值。方法103例经锁骨下静脉途径行永久性心脏起搏器置入术患者根据电极导线置入时是否保留撕剥式电极导线导引器分为非保留组(n=50),保留组(n=53),每组又根据置入起搏器类型分为单腔起搏器组和双腔起搏器组两个亚组。比较两组手术时间、X线曝光时间、电极导线放置失败率、手术并发症并随访切口及囊袋情况、起搏器工作状态等。结果保留组手术时间、X线曝光时间及电极导线放置失败率明显少于非保留组(68.8±18.3minvs77.5±18.9min;4.36±1.34minvs5.57±1.62min;0%vs7.9%,P均<0.05~0.01),亚组分析显示不论单腔、双腔起搏器置入,保留组手术时间、X线曝光时间均明显短于非保留组(P均<0.01)。保留组与非保留组各有1例术后出现需处理的囊袋血肿,2组术后随访5个月~4.3年,未见其他并发症,起搏器工作状态良好。结论经锁骨下静脉穿刺途径置入永久性心脏起搏器时,保留撕剥式电极导线导引器能缩短手术时间、X线曝光时间,减少电极导线置放失败率,值得在临床进一步推广应用。

Using value of peel away catheter introducer in cardiac pacemaker implantation through the subclavian vein puncture

Objective To investigate the using value of peel away catheter introducer in cardiac pacemaker implantation through the subclavian vein puncture. Methods 103 cases who were implanted pacemaker through the right subclavian vein puncture were individed into two groups according to whether or not retained peel away catheter introducer when catheter inputted as non-retained group(n=50) and retained group(n=53),and also into two subgroups as the single chamber and dual chamber according to implanted pacemaker types.Their procedure time, fluoroscopy time ,catheter inputted failure rate and complications were compared .The scores of incision, pocket and working situation of pacemaker were obtained. Results The procedure time, fluoroscopy time and catheter inputted failure rate in retained group were significantly less than those in non-retained group(68.8±18.3 min vs 77.5±18.9 min;4.36±1.34 min vs 5.57±1.62 min;0% vs 7.9%,all P<0.05~0.01),and subgroup analysed the procedure time and fluoroscopy time in single chamber subgroup and dual chamber subgroup in retained group were significantly less than those in non-retained group(all P<0.01).One pocket haematoma treated case was found in every group.Both groups were following up 5 months to 4.3 years, and no other complication was found.The working situation of pacemaker was good. Conclusion It is helpful to reduce procedure time,fluoroscopy time and catheter inputted failure rate, when cardiac pacemaker implantation through the subclavian vein puncture retained peel away catheter introducer.Popularizing this method is feasibility.