一种心腔内超声指导下的犬房间隔穿刺方法  

A method for transseptal puncture guided by intracardiac echocardiography in canine

作　　者：赵腾[1] 赵耀 刘超[1] 赵海娟 李珂 黄松群 郭志福[1] 曹江[1] 黄新苗[1] ZHAO Teng;ZHAO Yao;LIU Chao;ZHAO Hai-juan;LI Ke;HUANG Song-qun;GUO Zhi-fu;CAO Jiang;HUANG Xin-miao(Department of Cardiovasology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院心血管内科,上海200433

出　　处：《海军军医大学学报》2022年第4期372-376,共5页Academic Journal of Naval Medical University

基　　金：国家自然科学基金(81770506,81970278)。

摘　　要：目的探索一种心腔内超声(ICE)指导下的犬房间隔穿刺方法。方法对10只体重为10~15 kg的健康犬进行ICE指导下的房间隔穿刺术。肌内注射阿托品后经留置针推入丙泊酚诱导麻醉,顺利诱导后行气管插管,采用异氟烷吸入维持。经皮穿刺双侧股静脉后置入鞘管,经右侧鞘管送入房间隔穿刺针至上腔静脉并指向12点钟方向,经左侧鞘管送入ICE导管至右心房构建HomeView切面。将ICE导管打P弯后顺时针旋转,逐渐显示出主动脉根部、房间隔和卵圆窝,调整ICE导管使卵圆窝位于切面中心后固定ICE导管,整体回撤房间隔穿刺针及鞘管并缓慢顺时针旋转至3点钟方向,穿刺针、鞘滑落至卵圆窝时,可见“帐篷征”。固定穿刺鞘,推送穿刺针,穿过房间隔时“帐篷征”消失,推注肝素盐水确认,固定穿刺针,推送穿刺鞘,可见“双轨征”。退出穿刺针,肝素盐水冲管后置入左心房两圈半导丝,在切面中可见左心房两圈半导丝盘绕在左心房。术后处死5只实验犬并解剖心脏,观察有无心包腔积液及穿刺位置,其余犬30 d后处死并解剖心脏观察并发症情况。结果10只犬全部穿刺成功,其中9只犬一次性穿刺成功。手术操作时间为(5.2±1.4)min,透视时间为(24.9±4.5)s。即刻处死5只犬后解剖心脏,未见心包腔血性液体,房间隔穿刺点位于卵圆窝中心位置;其余犬术后30 d未见心肌损伤、血肿等并发症。结论ICE指导下的犬房间隔穿刺方法操作简便,有效性及安全性高。Objective To explore a method for transseptal puncture guided by intracardiac echocardiography(ICE)in canines.Methods Transseptal puncture was performed in 10 healthy canines weighing 10-15 kg guided by ICE.Anesthesia was induced by intramuscular injection of atropine and propofol.Isoflurane was used to maintain anesthesia after trachea cannula.After percutaneous puncture of the bilateral femoral veins,a sheath was inserted.Then,an transseptal puncture needle was delivered to the superior vena cava via the right sheath and pointing to the 12 o’clock direction.An ICE catheter was delivered to the right atrium via the left sheath to construct a“HomeView”.A P-bend was made in the ICE catheter,and the catheter was rotated clockwise to reveal the aortic root,atrial septum,and fossa ovalis.The ICE catheter was adjusted so that the fossa ovalis was located in the center of the section before the catheter was secured.The transseptal puncture needle and sheath were withdrawn and slowly rotated clockwise to the 3 o’clock position.The“tent sign”was visible once the needle and sheath reached the fossa ovalis.Once the sheath was fixed,the needle was inserted.The“tent sign”disappeared after crossing the atrial septum.An intravenous bolus of heparin saline was administered to confirm that the needle had reached the left atrium,fixing the needle and pushing the sheath,and the“double track sign”was visible.After withdrawing the needle and flushing the tube with heparin saline,two and a half coils of guidewire were placed in the left atrium,which were visible in the section.After surgery,5 canines were sacrificed and observed for the presence of pericardial cavity effusion and the puncture site,and the other canines were followed up for 30 days and the complications were recorded.Results All transeptal punctures were successful in 10 canines,including single puncture in 9 canines.The procedure duration was(5.2±1.4)min,and the exposure duration was(24.9±4.5)s.Five canines were sacrificed immediately after the

关 键 词：房间隔穿刺术 犬 心腔内超声 动物实验 手术时间 并发症 

分 类 号：R654.2[医药卫生—外科学]