经右颈外静脉床旁漂浮电极临时起搏临床研究

探讨由各种原因导致严重缓慢心律失常、心跳骤停及尖端扭转型室性心动过速时,经右颈外静脉紧急床旁漂浮电极临时起搏方法的疗效。26例采用床旁非X线条件下,经右颈外静脉穿刺,在黑泥鳅导丝引导下到达深静脉,将球囊漂浮电极置入深静脉,使之随血流漂浮送至右心室,根据电极进入深度结合体表II导联心电图特征、心腔内心电图ST段抬高以及起搏的效果确定有效起搏部位,实施紧急心脏起搏。根据体表II导联起搏心电图特征和血流动力学改善,判断心脏有效起搏和电极移位,各为25/26例(96.2%)和2/26例(7.6%)。并发局部出血1/26例(3.8%),无穿刺部不可控制出血。该方法操作简便,疗效可靠,并发症少,是一项安全有效的起搏方法。尤其适用于不易搬动又急需心脏起搏治疗的患者,以及需要溶栓或抗凝治疗而禁忌深静脉穿刺的患者。

Clinical Study of Emergency Bedside Temporary Cardiac Pacing by Sacculated Floating Electrode through Right External Jugular Vein

The purpose of this study is to investigate the curative effect of emergency bedside temporary cardiac pacing in patients with serious bradycardia or cardiac arrest or TDP ventricular tachycardia.In 26 cases,guided by the QRS morphology of pacing ECG the pacing electrode was inserted into deep right external jugular vein and with blood flows to right ventricle without roentgenoscopic guidance.According to the depth of the electrode inserted,characteristic of lead II body surface electrocardiogram,the ST section rising in the intracardiac electrocardiogram and the pacing effect,the efficient pacing position was located and followed with the emergency cardiac pacing.According to the characteristic of lead II body surface pacing electrocardiogram and the blood flow dynamics improvement,the effective cardiac pacing and the electrode shifting were judged respectively as 25/26 cases(96.2%) and 2/26 cases(7.6%).The complication of partial bleeding was 1/26 cases(3.8%).There was no case of non-controllable hemorrhage at the puncture point.This method was proved to be a safe and effective way of pacing with the merit of simple operation,reliable curative effect and less complication.It is specially applicable to patients who are difficult to move around but need emergency cardiac pacing as well as patients who need thrombolysis or anticoagulant therapy while are unable to endure deep vein puncture.