永存左上腔静脉患者永久性心脏起搏导线植入途径及可行性研究  

Exploration and Feasibility of Implantation Pathways of Permanent Pacemaker Lead in Patients with Persistent Left Superior Vena Cava

作　　者：马彦卓[1] 侯广道 汝磊生[1] 杨茜 任振芳 袁江永[3] 刘红彬[4] 齐书英[1] MA Yanzhuo;HOU Guangdao;RU Leisheng;YANG Qian;REN Zhenfang;YUANJiangyong;LIU Hongbin;QI Shuying(Cardiovascular Department,Bethune International Peace Hospital of Chinese People's Liberation Army,Shijiazhuang 050082,China;Cardiovascular Department,Xingtai Third Hospital,Xingtai 054000,China;Cardiovascular Department,Affiliated Hospital of Hebei University of Engineering,Handan 056002,China;Cardiovascular Department,Shijiazhuang Third Hospital,Shijiazhuang 050043,China)

机构地区：[1]中国人民解放军白求恩国际和平医院心内科,河北省石家庄市050082 [2]河北省邢台市第三医院心内科,054000 [3]河北工程大学附属医院心内科,河北省邯郸市056002 [4]河北省石家庄市第三医院心内科,050043

出　　处：《实用心脑肺血管病杂志》2020年第10期127-130,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省医学科学研究重点课题计划项目(20150372)。

摘　　要：背景永存左上腔静脉(PLSVC)属于一种先天性血管畸形,临床较少见,但在永久性心脏起搏器植入术中发现PLSVC可增加手术难度。目的分析PLSVC患者永久性心脏起搏导线植入途径及可行性,以为临床治疗提供参考依据。方法选取2010年4月—2019年12月中国人民解放军白求恩国际和平医院、邢台市第三医院、河北工程大学附属医院及石家庄市第三医院心内科收治的窦房结功能不全并PLSVC患者7例,均行永久性心脏起搏器植入术。记录患者手术情况及术中并发症发生情况,并比较患者术前及术后1个月心脏起搏参数。结果起搏器类型:心房频率应答型起搏器(AAIR)1例,双腔频率应答型起搏器(DDDR)6例。起搏导线植入部位及数目:被动心房电极导线1根,主动心房电极导线6根,心室主动电极导线6根。起搏导线植入途径:经冠状窦(CS)送入导引钢丝和起搏导线1例,但导引钢丝难以通过,故改为右侧锁骨下静脉成功送入;经左侧腋静脉送入起搏导线4例;经左侧锁骨下静脉送入起搏导线2例。与术前比较,患者术后1个月右心房、右心室起搏导线阈值、阻抗、感知比较,差异无统计学意义(P>0.05)。结论PLSVC患者经CS植入永久性心脏起搏器可增加手术操作难度,而选用合适的预塑型导引钢丝可提高PLSVC患者手术成功率,且起搏参数稳定,安全有效。Background Persistent left superior vena cava(PLSVC),a congenital vascular malformation rarely seen clinically,may increase the operative difficulty if being found incidentally during permanent pacemaker implantation.Objective To explore the implantation pathways of permanent peacemaker lead and evaluate their feasibility in patients with PLSVC,in order to provide a reference for clinical treatment.Methods From April 2010 to December 2019,7 patients with sinus node dysfunction and PLSVC were selected from the Cardiovascular Department of 4 hospitals(Bethune International Peace Hospital of Chinese People's Liberation Army,Xingtai Third Hospital,Affiliated Hospital of Hebei University of Engineering and Shijiazhuang Third Hospital).Permanent cardiac pacemaker implantation was performed in all the participants,and during which intraoperative conditions and the incidence of intraoperative complications were recorded.Preoperative and 1-month postoperative cardiac pacing parameters were compared.Results The AAIR peacemaker and DDDR peacemaker were used in 1,and 6 patients,respectively.1 passive fixation atrial lead,6 active fixation atrial leads and 6 active fixation ventricular leads were used.1 patient was changed to right subclavian vein due to the pacemaker lead placed by the guide catheter in the CS could not be advanced to right ventricle despite many attempts;pacemaker lead was delivered via left axillary vein in 4 patients;pacemaker lead was delivered via left subclavian vein in 2 patients.There were no significant differences in the threshold,impedance,sensing in pacemaker lead of right atrium and right ventricle before operation and at 1 month after operation(P>0.05).Conclusion Implantation of permanent pacemaker via CS in PLSVC patients can increase the difficulty of operation,but using the appropriate pre-molded guide wire can improve the success rate of operation,with stable cardiac pacing parameters,and the technique is safe and effective.

关 键 词：动静脉畸形 永存左上腔静脉 冠状窦 永久性心脏起搏器植入 起搏电极导线 

分 类 号：R654.4[医药卫生—外科学]