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目的:评估床旁临时心脏起搏器安置术救治急危重患者心脏急症的可行性和有效性。方法:对472例伴发多种类型心律失常的患者在动态心电监测下采用床旁经静脉穿刺法行心脏临时起搏器安置术,入管路径依次为双侧锁骨下静脉276例次、右侧颈内静脉190例次、右侧股静脉6例次。评估临床可操作性、应用指针和范围、起搏后疗效、术中及术后并发症及并发症处理等。结果:459例次经床旁盲插导管成功,成功率97.25%。平均操作时间3～10min。应用于心脏疾病及心脏疾病以外因素导致的心律失常的急救,导管插入成功都能正常起搏心脏,起搏器安置术中、起搏应用过程中发生室颤、心脏穿孔、血气胸、导管脱落、感知起搏不良等相关并发症21例,占4.45%。结论:床旁临时心脏起搏术在纠正恶性心律失常的治疗中具有快捷、损伤小、灵活性高、疗效好、并发症少等特点,在危重症患者的综合救治中优势明显。
Objective: To evaluate the feasibility and effectiveness of bedside temporary cardiac pacemaker placement in emergency treatment of acute critical cardiac events. Methods: 472 patients with multiple types of arrhythmias underwent ambulatory cardiac pacemaker placement by bedside venous puncture under ambulatory electrocardiographic monitoring. The path of admission was followed by 276 bilateral subclavian veins and the right 190 cases of lateral jugular vein, 6 cases of right femoral vein. Assess clinical maneuverability, application guidelines and ranges, post-pacing efficacy, intraoperative and postoperative complications and complications management. Results: 459 cases of transcranial placement of blind catheterization success rate of 97.25%. The average operating time of 3 ~ 10min. Applied to the first aid of arrhythmia caused by factors other than heart disease and heart disease, the successful cardiac catheterization can be normal pacemaker implantation, pacemaker placement of ventricular fibrillation, cardiac perforating, blood pneumothorax, catheter fall off , 21 cases related to perceived pacing and other complications, accounting for 4.45%. Conclusions: Bedside temporary cardiac pacing has the advantages of quickness, small injury, high flexibility, good curative effect and few complications in the treatment of malignant arrhythmia. It has obvious advantages in the comprehensive treatment of critically ill patients.