经上腔静脉途径直接穿刺房间隔动物模型的实验研究  

Puncture of atrial septal via superior vena cava access in minipigs

作　　者：孙韬[1] 赵言玮[2] 朱福音 梁伟国[1] 周卿[4] 张津津[1] 周闻白[3] 罗心平[1] 施海明[1] 

机构地区：[1]复旦大学附属华山医院心内科,上海201907 [2]复旦大学附属华山医院急重症医学科,上海201907 [3]复旦大学附属华山医院内分泌科,上海201907 [4]上海交通大学附属新华医院心内科

出　　处：《中华心律失常学杂志》2016年第1期69-72,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：上海市科学技术委员会科技支撑计划（13441900702、13441900700、13441900701）;上海市卫生和计划生育委员会科研课题（201440556）

摘　　要：目的探索从上腔静脉直接穿刺房间隔植入左心室导线的可行性和安全性。方法入选12只小型猪，体重（35＋4）kg，不分雌雄，随机数余数分组法分为2组：上腔组和下腔组，每组6只。下腔组：Ross法经股静脉穿刺房间隔；上腔组：Ross法定位房间隔部后从左侧颈静脉直接穿刺房间隔。对比2组手术、x线曝光时间；术后穿刺部位最大直径以及手术前、后左心室射m分数（LVEF）；解剖标本观察房间隔穿刺点的实际位置；对比手术并发症发生情况。结果以颈静脉为入路可以成功直接穿刺房间隔。上、下腔组穿刺部位直径[（2．4±1．1）mm对（2．3±0．9）mm，P〉0．05]，上腔组穿刺前后LVEF[（0．64±0．05）对（0．63±0．03），P〉0．05]、下腔组穿刺前后LVEF[（0．62±0．05）对（0．63±0．04），P〉0．05]差异无统计学意义。解剖后发现上腔组穿刺部位3例位于卵圆窝、2例在房间隔卵圆窝下部；下腔组穿刺部位1例位于卵圆窝、4例在房间隔卵圆窝下部。结论经上腔静脉直接穿刺房间隔是一项可行并且安全的手术方式。Objective To evaluate the feasibility of new technique for puncture of the interatrial sep- turn via superior vena cava. Methods The puncture needle and catheter was modified firstly.Twelve minipigs were assigned into this test, 6 minipigs in femoral group （interatrial septum was punctured according to Ross method） and another 6 minipigs in jugular group （interatrial septum was punctured via jugular vein access）. The diameter of interatrial septum puncture,left ventricular ejection fraction （LVEF） of pre-operation and after- operation were recorded by echocardiography. The operation, radiation time and complication was recorded. Af- ter dissection, the location of exact puncture defect was observed. Results With the help of recreated puncture catheter and guide wire, puncture of interatrial septum via superior vena cava was achieved successfully. Echo- cardiography confirmed that the diameters of interatrial septum puncture in femoral and jugular groups were （2. 4±1.1 ） mm vs. （2. 3±0. 9） mm （ P〉0.05）, no statistically significant. In jugular groups （ n = 5）, LVEF before and after surgery were 0. 64±0. 05 vs. 0. 63±0. 03 （P〉0. 05） ,no statistically significant. And in femoral group （ n = 5）, LVEF before and after surgery was 0. 62±0.05 vs. 0. 63±0. 04, no statistically significant. There was no either malignant arrhythmia, cardiac rupture in the surgery of both groups. There was one cardiac tam- ponade case in jugular group. With the surgery practiced more, the overall surgery and radiation time decreased. Actually, the surgery and radiation time in jugular group was less than that in femoral group. After dissection, we found out that puncture defect of 3 cases in jugular group was in fossae ovalis, and the puncture defect in anoth- er 2 cases located in the lower part of the fossa ovalis in atrial septal. Likewise, in femoral group, there were on- ly one case in fossa ovalis and another 4 were in the lower part of the fossa ovalis in atrial septal. Conclusion It is f

关 键 词：心脏再同步治疗 上腔静脉 房间隔穿刺 可行性 安全性 

分 类 号：R-332[医药卫生] R541