微创介入方舱内紧急救治高度房室传导阻滞犬的可行性研究  

A Feasibility Study on Emergency Treatment of Advanced Atrioventricular Block Performed in a Comprehensive Operation Cabin in Dogs

作　　者：荣晶晶[1,2] 梁明[1] 霍煜[1] 姚天明[1] 孙景阳[1] 梁延春[1] 宣风琦[1] 孙毅[1] 梁卓[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心血管内科,沈阳110016 [2]第三军医大学研究生队,重庆400038

出　　处：《解放军医药杂志》2014年第1期1-4,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：全军"十二五"重点课题(BWS12J006);全军医学科技青年培育项目(13QNP003);辽宁省自然科学基金(201202241)

摘　　要：目的以综合手术救治方舱为救治平台,研究在严重自然灾害现场应用心脏永久性起搏器植入术救治高度房室传导阻滞的可行性。方法 3只成年健康家犬,常规麻醉后经股静脉穿刺,利用射频消融术对心脏传导通路中的房室结区希氏束进行精确靶向毁损,以构建高度房室传导阻滞模型,后经锁骨下静脉将电极送至心室内并安装永久性VVI心脏起搏器。观察并发症发生情况、术后2周家犬存活情况,并定期监测心脏电生理。结果经房室结区消融后高度房室传导阻滞犬模型造模成功(Ⅱ度房室传导阻滞2只,Ⅲ度房室传导阻滞1只)。永久性起搏器植入手术顺利,手术时间(55.7±16.1)min,未发生并发症。术后2周家犬均存活,心脏电生理监测结果显示心律恢复正常。结论在医疗条件极度匮乏的地震等严重自然灾害紧急救援期以及较长的灾后重建期间,依托综合手术方舱为高度房室传导阻滞患者实施心脏起搏器植入术安全、可行,综合手术方舱的应用将有望改善对灾区高度房室传导阻滞患者的救治现状。Objective To assess the feasibility of pacemaker implantation in treatment of advanced atrioventricular block in a comprehensive operation cabin under the circumstances of severe natural disasters. Methods Three healthy adult dogs underwent transfemoral venepuncture after conventional anesthesia, and the atrioventricular nodal region and HIS bundle in atrioventricular conductive channels underwent exact target damage with radiofrequency ablation to establish models of advanced atrioventricular block, and then the dogs were implanted with VVI permanency cardiac pacemakers after electrodes were sent to the heart through subclavian veins. Complications and survival rates of the dogs were observed two weeks after operations, and the changes of cardiac electrophysiology were periodically detected. Results Dog models of advanced atrioventricular block were successfully established after ablation of atrioventricular nodal region （2 dogs with degree II atrioventricular block, 1 dog with degree III atrioventricular block）. Permanent cardiac pacemakers were successfully implanted without complications, and the average operation time was （55.7 ± 16. 1） min. All the dogs survived 2 weeks after the operation, and cardiac electrophysiology results showed that heart rhythms were normal. Conclusion In the period of emergency rescue and long-term reconstruction after a serious natural disaster, the emergency treatment of high-grade atrioventricular block with cardiac pacemakers in a comprehensive operation cabin is safe and feasible, and can be expected to improve the treatment of high-grade atrioventricular block in a disaster-stricken area.

关 键 词：微创介入方舱 灾害 救援作业 心脏传导阻滞 心脏起搏器 人工 狗 

分 类 号：R-332[医药卫生] R541.761