平针法盲穿腋静脉与常规锁骨下静脉植入起搏导线2902例回顾性分析  

A retrospective cohort study of 2902 cases of pacemaker electrode insertion through blind axillary vein puncture with shallow needle trajectory and traditional subelavian vein puncture

作　　者：聂鹏[1] 幺天保[1] 张琪[1] 金艳[1] 臧敏华[1] 周笙珩[1] 孙嘉腾 徐从健 毛家亮[1] 卜军[1,3] NIE Peng;YAO Tian-bao;ZHANG Qi;JIN Yan;ZANG Min-hua;ZHOU Sheng-heng;SUN Jia-teng;XU Cong-jian;MAO Jia-liang;PU Jun(Depart-ment of Cardiology,Renji Hospital,School of Medieine,Shanghai Jiaotong University,Shanghai 200127.China;Department of Cardiology.Shengli Oifield Central Hospital,Dongying 257034.Shandong,China;Shanghai Clinieal Medical Research Center for Geratrie Diseases,Shanghai 200040,China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127 [2]胜利油田中心医院心内科,山东东营257034 [3]上海市老年疾病临床医学研究中心,上海200040

出　　处：《中国心脏起搏与心电生理杂志》2023年第2期122-124,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：上海市自然科学基金项目(21ZR1439100);上海市卫生健康委员会临床重点专科建设项目(shslczdzk06204);上海市申康医院发展中心新兴前沿技术联合攻关项目(SHDC12022102);上海市老年疾病临床医学研究中心项目(19MC1910500);上海市自然科学基金项目(19ZR1430300);上海交通大学“转化医学交叉研究基金”(ZH2018QNB21)。

摘　　要：目的比较平针法盲穿腋静脉与常规锁骨下静脉穿刺植入电极导线的相关并发症发生率。方法回顾性分析自2010年1月至2021年12月于本科室植入普通心脏起搏器患者2902例,根据穿刺路径分为腋静脉组(n=2377)和锁骨下静脉组(n=525),分析两组患者穿刺相关并发症以及长期随访下导线磨损发生率。结果两组患者在起搏器植入术即刻或短期并发症,如出血血肿、刀口感染、气胸、血胸、周围神经损伤、导线脱位、静脉血栓、电极穿孔等方面无差异。而在长期随访中,腋静脉穿刺植入导线无一例发生导线磨损甚至断裂发生,而锁骨下静脉组发生率为1.14%(6/525)。结论相比锁骨下静脉穿刺,平针法盲穿腋静脉植入起搏电极,成功率高,可避免远期导线磨损的发生。Objective To compare the incidence of associated complication in two methods of implanting electrode lead,consisting of shallow needle trajectory in blind axillary vein puncture and traditional subclavian vein puncture.Methods 2902 patients with pacemakers implanted from January 2010 to December 2021 were retrospective analyzed.According to the puncture path,they were divided into axillary vein group(n=2377)and subclavian vein group(n=525),to analyse their associated complication of puncture and the risk of wire worn after long-term follow-up.Results There were no difference between the two groups in immediate or short-term complications of pacemaker implantation,such as hemorrhage,wound infection,pneumothorax,hemothorax,peripheral nerve injury,wire dislocation,venous thrombosis and electrode perforation.In the long-term follow-up,there was no wire worn and broken in the axillary vein puncture,while 1.14%(6/525)in the subclavian vein puncture.Conclusion Compared with the subclavian vein puncture,the superiority of implanting electrode lead by the shallow needle trajectory in blind axillary vein is obvious,the success rate is higher and the complication is less.Especially it can avoid wire worn occurring at a specified future date.

关 键 词：心血管病学 心脏起搏器 腋静脉 锁骨下静脉 并发症 导线磨损 

分 类 号：R318.11[医药卫生—生物医学工程]