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时间:2019-10-17
《气囊电极床边紧急心脏临时起搏的临床观察》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、气囊电极床边紧急心脏临时起搏的临床观察屮国心脏起搏与心电生理朵志2(X)()年第2期第14卷临床研究作者:陈国雄叶军俞晓军李略沈凯俞基康王晓华袁国裕单位:浙江省舟山市人民医院心内科,浙江舟山316004关键词:心脏起搏,临时;球囊电极;急症处理摘要总结36例经右颈内静脉、左锁佇下静脉及右股静脉三种不同的途径穿刺插管,行气喪电极床边紧急心脏临吋起搏的经验。按Seldiger方法行静脉穿刺置管,按Swan-Ganz球喪导管操作方法推送气囊电极导管,在无X线透视条件下,根据心腔内心电图、室性早搏出现或体表起搏心电图判断电极进入右室,行右室心
2、内膜临时起搏。结果:36例全获成功,其中右颈内静脉(中位法)16例、左锁骨下静脉(下位法)12例、右股静脉8例。前两者开始穿刺至起搏成功时间为3—10min,后者为10〜25min。起搏效果肯定,起搏时间2~20天。经股静脉插管者2例误入下腔静脉分支,1例导管扭曲受阻,此3例重新插管起搏成功。经左锁骨下静脉插管1例谋入左颈内静脉,改右颈内静脉起搏成功。全组除11例腔内心电图和5例边起搏边送管方法确定导管头位置外,余20例在边送管边观察室性早搏出现的方法判断电极进入右室。术后胸片证实导管头位置与体表起搏图形定位的部位完全一致。除3例电极
3、移位和2例短阵室性心动过速外,全部病例未发生心脏穿孔、气胸、血胸及感染等并发症,除2例死于原发病外,余均痊愈出院。结论:本法创伤小、方便快速、安全有效、无需X线引导,值得急救推广应用。中图分类号R541.7+2文献标识码A文章编号1007—2659(2000)02—0110—03ExperinceofInstallationofEmergencyBedsideTemporaryCardiacPacemakerinPatientswithSeriousCardiacArrhythmia・CHENGuo-xiong,YEJun,YUXia
4、o-jun,etal.Topresenttheresultofinstallationofbedsideemergencytemporarycardiacpacingwithballoon-tippedelectrodedeviceviatherightjurgularjeftsubclavian,orrightfemoralvein.Thirty-Sixpatientswithseriousarrhythmiaunderwenttoinstallthetemporarypacemaker.UsingSeidingerandSwan-
5、Ganzproceduces^aballon-tippedfloat-directedpacingelectrodewasintroducedintotherightventricle,Thecardiacpacingwasmonitoredbymeansofintracardiacelectrographicdevice,provokedventricularprematurebeatsandsuperficialpacingelectrography.Conventionalchestx-rayfilmsweretakenforc
6、ontrol.Results:Allpatientsweresuccessfullypaced.Theroutesofinsertionoftheelectrodewerethroughthe(blowingveins:Rightjungularveincannula(n=16)Jeftsubclavicularvein(n=12)andrightfemoralveinin8cases.Theoveralloperationduration(frompuncturingtosuccessfullypacing)was3~10minut
7、esthroughthejugularorsubclavianveinand10~25minutesinfemoralvein,Allofthoseproblemsweresolvedbymanualmanipulationwithnodifficuty.Thepacemakerelectrodepositionandcardiacpacingwasmonitoredbymeansofintracardiacelectrographyin11cases,superficialpacingelectrographyin5casesand
8、provokedventricularprematuresystolesin20cases.Nocomplicationoradversereactionwasoccurredinthisseries.Thepacing
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