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目的探讨一种适合基层医院开展的快速、安全、简便的临时心脏起搏器植入方法。方法选取42例严重缓慢型心律失常患者,在床旁体表心电监护引导下,通过Seldinger穿刺技术,在无X线透视条件下将临时起搏漂浮电极导管送入右心室,通过体表心电图QRS波群形态确定电极位置。术后复查标准导联常规心电图,拍床旁胸片观察电极位置。记录放置电极导管所花费的时间与平均起搏时间,观察临时起搏操作并发症。并与同期11例X线透视引导下普通电极导管心脏临时起搏进行对比分析。结果42例患者穿刺均获得成功,经X线证实,电极顶端全部位于右室心尖部,电极一次性到位成功率100%,安置电极导管平均操作时间(8.9±2.0)min,对照组为(7.9±2.2)min,两组比较差异无统计学意义(P>0.05)。但漂浮电极起搏组平均起搏所需时间明显缩短,起搏天数1~12 d,平均4 d,两组均未见并发症发生。结论床旁漂浮电极导管可在没有X线设备下紧急起搏而不需搬动危重病患者,具有操作简单、起搏迅速、疗效肯定及相对安全的特点,普通临床医生非常容易掌握,适合基层医院推广应用,对基层医院提高危重病抢救成功率以及降低缓慢型心律失常患者外科手术风险具有重要意义。
Objective To explore a rapid, safe and easy method of implanting temporary cardiac pacemaker suitable for primary hospitals. Methods Forty-two patients with severe arrhythmia were enrolled in this study. Under the guidance of bedside epicardial electrocardiogram (ECG), Seldinger puncture technique was used to deliver the temporary pacing floating electrode catheter into the right ventricle without fluoroscopy. QRS complex shape to determine the electrode position. Postoperative review of the standard lead ECG, film side of the chest to observe the electrode position. Record the time it takes to place the lead and the average pacing time to observe the complications of the temporary pacing operation. And with the same period 11 cases under the guidance of X-ray general lead temporary cardiac pacing catheter comparative analysis. Results The puncture was successful in all 42 patients. The X-ray showed that the tip of the electrode was all located in the apex of the right ventricle. The success rate of the electrode was 100%, the average operation time of the electrode was 8.9 ± 2.0 min, ± 2.2) min, no significant difference between the two groups (P> 0.05). However, the average time required for pacing in floating electrode pacing group was significantly shortened, and the number of pacing days was 1 ~ 12 days with an average of 4 days. No complication occurred in either group. Conclusion The bedside floating electrode catheter can be emergency pacing without X-ray equipment without moving critical patients, with simple operation, rapid pacing, positive effect and relative safety features, the average clinician is very easy to grasp, suitable for the grassroots The promotion and application of hospitals are of great significance for improving the success rate of rescue of critical illness in primary hospitals and reducing the surgical risk of patients with bradyarrhythmia.