不同方法定位穿刺腋静脉植入起搏电极的临床研究  

Different kinds of approaches to percutaneous venipuncture to axillary vein for implanting permanent pacemaker electrodes

作　　者：蒋金法[1] 刘如辉[1] 徐文俊[1] 许嘉鸿[1] 宋浩明[1] 

机构地区：[1]上海同济大学附属同济医院心内科,上海200065

出　　处：《中国介入心脏病学杂志》2015年第4期208-212,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨3种不同定位方法穿刺腋静脉植入起搏电极的临床价值和安全性。方法根据随机表将患者分入体表解剖定位组(30例)、透视下骨性标志定位组(30例)、对比剂定位组(30例)以及锁骨下静脉组(对照组,30例),其中体表解剖定位组、透视下骨性标志定位组和对比剂定位组统称为腋静脉穿刺组。穿刺成功后按照常规方法植入各种起搏器和电极。观察4组不同穿刺方法的穿刺次数、所用时间、成功率及并发症发生情况。结果 120例患者均成功植入各种起搏器和电极。穿刺腋静脉各组与对照组比较,总穿刺成功率差异无统计学意义(P>0.05);对比剂定位组穿刺腋静脉成功率100%,但需要对比剂和准备时间;其次为透视下骨性标志定位组成功率93.3%;经体表解剖定位组和经锁骨下静脉穿刺组的穿刺成功率均为86.7%。腋静脉穿刺组穿刺次数中位数少于锁骨下静脉穿刺组(3比4,P<0.05);观察组穿刺平均耗时短于对照组[(3.9±1.3)min比(4.6±2.1)min,P<0.05]。对于心脏再同步化治疗,经腋静脉穿刺平均手术时间少于对照组(126.0±12.0)min比(146.0±16.0)min,P<0.05]。腋静脉穿刺组90例患者中共3例(3.3%,3/90)出现并发症,锁骨下静脉穿刺组30例患者中共5例(16.7%,5/30)发生并发症,两组并发症发生率比较差异有统计学意义(P<0.05)。结论 3种不同的定位方法穿刺腋静脉植入起搏电极均有很好的临床疗效和安全性,总体优于经锁骨下静脉穿刺术。Objective To evaluate the safety and feasibility of three different kinds of approaches to veinpuncture to axillary vein for permanent pacemaker implantation. Methods 120 patients who needed implantation of permanent pacemakers were divided into four groups： group A（ puncturing axillary vein by anatomic location, n = 30）, group B（ puncturing axillary vein by bone landmark, n = 30）, group C（puncturing axillary vein by venography,n = 30） and group D（puncturing subclavian vein,n = 30）.Number of times of puncture,procedure time,venipuncture success rate and complications of operation were compared among the 4 groups. Results All the 120 patients received pacemaker implantion successfully.The success rate of puncturing axillary vein by venography had the highest success rates（ 100%） and the longest preparing time. The success rate of puncturing axillary vein by bone landmark was 93. 3%.Puncturing axillary vein by anatomic location and puncturing subclavian vein had same success rates of 86. 7%. Compared with subclavian vein puncture in group D,puncturing axillary vein needed less puncture times（ Median 3 vs. 4,P〈0. 05）,operation time [（3. 9 ± 1. 3） min vs.（4. 6 ± 2. 1） min,P〈0. 05]and incidence of complication（3. 3% vs. 16. 7%,P〈0. 05）. The procedure time of CRT was shorter in puncturing axillary vein than in puncturing subclavian vein [（ 126 ± 12） min vs.（ 146 ± 16） min,P〈0. 05]. Conclusions All of the three different methods of percutaneous venipuncture to axillary vein for implanting permanent pacemaker electrodes were much more safe and effective when compared with puncturing subclavian vein. With the increase in experience,puncturing axillary vein may be an alternative for puncturing subclavian vein to avoid its complications.

关 键 词：定位 穿刺 腋静脉 起搏电极 

分 类 号：K541.7[历史地理—历史学]