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目的总结本院102例气囊漂浮电极导管床旁心脏起搏的临床应用经验。方法收集本院1995年至今缓慢性心律失常患者102例,其中紧急临时起搏用于危重抢救病例67例,外科择期手术预防性起搏35例。根据操作者经验及习惯在床旁以seldinger方法穿刺左锁骨下静脉58例或右颈内静脉44例,在无X线透视条件下,沿动脉鞘管插入气囊电极,缓慢推送电极,根据心电监护II导联QRS波形态、心腔内心电图、体表起搏心电图判断电极进入右心室,观察起搏效果。结果102例均成功起搏,从穿刺到成功起搏用时为10～15min,起搏时间2～11d。其中1例经左锁骨下静脉穿刺置管钢丝误入左颈内静脉,重新穿刺送管后顺利起搏。另有3例在电极送入右心室时出现短阵室性心动过速,轻柔退管后室速消失;8例术后6～12h内出现间断起搏,为电极移位,重新调整电极后正常起搏。全部病例未发生心肌穿孔、气胸、感染、导管断裂等严重并发症。结论气囊漂浮电极床旁心脏临时起搏安全有效、创伤小、并发症少、方便快捷,既可用于危重患者的抢救工作,同时也能预防性起搏保护外科患者安全渡过围手术期,值得临床推广应用。
Objective To summarize the clinical experience of 102 cases of balloon catheter pacing in our hospital. Methods Totally 102 patients with bradyarrhythmia in our hospital from 1995 to now were included. Among them, 67 cases were used for critical rescue and emergency pacing in 35 cases. According to the operator’s experience and habits at the bed by seldinger puncture the left subclavian vein in 58 cases or 44 cases of right internal jugular vein in the absence of fluoroscopy conditions, along the arterial sheath inserted into the balloon electrode, the electrode slowly push, according to the ECG Guard II lead QRS wave morphology, intracardiac electrocardiogram, surface pacing ECG to determine the electrode into the right ventricle, observe the pacing effect. Results 102 cases were successful pacing, from puncture to successful pacing for 10 ~ 15min, pacing time 2 ~ 11d. One case of left subclavian vein catheterization catheterization into the left internal jugular vein, re-puncture tube smooth pacing. In the other 3 cases, short-tailed ventricular tachycardia occurred when the electrode was delivered to the right ventricle and ventricular tachycardia disappeared after gentle back-off. In 8 cases, intermittent pacing occurred within 6 ~ 12 hours after operation, which shifted the electrode and readjusted the electrode Normal pacing. No cases of myocardial perforation, pneumothorax, infection, catheter rupture and other serious complications. Conclusion It is safe and effective that the temporary cardiac pacing of airbag floating electrode bed is safe and effective with less trauma, fewer complications and quick and convenient operation, which can be used for rescue work of critically ill patients as well as preventive pacing to protect surgical patients safely through perioperative period. Clinical application.