经颈内静脉放置心内膜临时起搏导线的临床经验  

Clinical experience of placing endocardial temporary pacing wire through the internal jugular vein

作　　者：王慧琳 廖庆武 胡艳 郭克芳 徐丽颖 WANG Hui-lin;LIAO Qing-wu;HU Yan;GUO Ke-fang;XU Li-ying(Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2018年第6期863-865,883,共4页Fudan University Journal of Medical Sciences

摘　　要：目的探讨心脏手术的患者经颈内静脉放置心内膜临时起搏导线的可行性。方法回顾性分析2014年1月至2017年6月在复旦大学附属中山医院心外科行手术治疗的部分患者的临床资料。其中男56例,女62例;年龄37～89岁,平均(62.5±12.6)岁。行再次手术微创三尖瓣置换术56例,经心尖主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)60例,术前Ⅲ°房室传导阻滞(atrioventricular block,AVB)2例。术前经颈内静脉放置6.0F鞘,经鞘放置心内膜临时起搏导线。临时起搏效果经尝试起搏法、超声心电图引导法或数字减影血管造影(digital subtraction angiography,DSA)法确认。结果经颈内静脉放置心内膜临时起搏导线成功率100%,无严重并发症发生,临时起搏导线到位良好,起搏及感知正常,术后传导阻滞发生率为13.56%,永久起搏器植入率为10.17%。结论对于部分心脏外科手术患者,经颈内静脉放置心内膜临时起搏导线安全可行,可提高围术期的安全性。Objective To explore the feasibility of placing endocardial temporary pacing wire through the internal jugular vein before induction in partial cardiac surgery patients. Methods A database was analysed retrospectively of partial patients undergoing cardiac surgeries in the Department of Cardiac Surgery,Zhongshan Hospital,Fudan University between Jan.,2014 and Jun.,2017.There were 56 males and62 females with an age of 37-89 years[(62.5±12.6)years].Fifty-six patients were undergone reoperation of minimally invasive tricuspid valve replacement.Sixty patients were undergone transcatheter aortic valve replacement(TAVR).Two patients had Ⅲ°atrioventricular block(AVB)before surgery.Among these patients,the 6.0 F sheaths were placed through the internal jugular vein and the endocardial temporary pacing wires were placed through the sheaths.The effectiveness of the temporary pacing was checked by inducing paced rate,echocardiography ordigital subtraction angiography(DSA). Results The successful rate of placing endocardial temporary pacing wire through the internal jugular vein was 100%.No serious complications occurred.The temporary pacing could reach its proper position and work normally.The incidence of conduction block after operation was 13.56%,and the rate of permanent pacemaker implantation was 10.17%. Conclusions It is safe and feasible to insert endocardial temporary pacing wire through the internal jugular vein in partial cardiac surgery patients.It can improve the safety of perioperative period.

关 键 词：再次手术 心内膜临时起搏 心脏手术 颈内静脉 

分 类 号：R654.2[医药卫生—外科学]