机构地区:[1]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院),山西太原030032
出 处:《中国心脏起搏与心电生理杂志》2023年第4期294-298,共5页Chinese Journal of Cardiac Pacing and Electrophysiology
摘 要:目的 观察头静脉解剖变异情况及心血管植入型电子器械(CIED)经头静脉植入术中指标,为经头静脉置入起搏电极提供经验。方法 观察2013年1月至2021年10月山西医科大学第三医院心内科符合CIED植入适应证并植入CIED的患者资料,在经头静脉置入起搏电极术中通过解剖分离及X线透视下观察导丝走行,确定患者头静脉局部解剖及走行情况,从三个方面进行总结:(1)将头静脉按局部解剖分为标准走行和复杂走行。标准走行:头静脉位于皮下脂肪层下,胸大肌三角肌间沟内,切开皮肤分离脂肪可直接暴露头静脉;复杂走行:头静脉为胸大肌三角肌间沟表面有肌层覆盖,需分离表面肌层才能暴露肌间沟,或与胸大肌三角肌肌层伴行。(2)头静脉按术中置入起搏电极数量分为:Ⅰ型:头静脉能顺利置入2根及2根以上起搏电极。Ⅱ型:头静脉较细,需沿头静脉走行切开置入起搏电极。Ⅲ型:头静脉细小,无法置入起搏电极。(3)将存在变异的头静脉称之为变异走行头静脉,包括跨越锁骨走行于锁骨上、汇入颈内静脉、汇入上腔静脉、位于胸大肌三角肌间沟外侧、走行迂曲、缺如等。对不同头静脉分组的手术时间、X线曝光时间进行比较。结果 共纳入466例。头静脉解剖及走行情况:(1)局部解剖(不包含头静脉缺如病例12例):标准走行头静脉占比66.7%(303例),复杂走行头静脉占比33.3%(151例)。(2)术中置入起搏电极数量(不包含头静脉缺如病例12例):Ⅰ型占比68.5%(311例);Ⅱ型占比24.7%(112例);Ⅲ型占比6.8%(31例)。(3)变异走行头静脉占比8.6%(40例),包括跨越锁骨走行于锁骨上4例(0.9%)(其中1例合并位于胸大肌三角肌间沟外侧)、汇入颈内静脉8例(1.7%)、汇入上腔静脉3例(0.6%)、位于胸大肌三角肌间沟外侧8例(1.7%)、走行迂曲5例(1.1%)、缺如12例(2.6%)。头静脉入路植入CIED成功率为83.3%。并发症发生率为2.6%。对于单腔�Objective To observe the anatomical variation of cephalic vein and the indexes of cardiovascular im-planted electronic device(CIED)implantation through cephalic vein,and to provide experience for the implantation of pacemaker electrode through cephalic vein.Methods The data of patients who met the indications for CIED im-plantation and were implanted with CIED in the Department of Cardiology of the Third Hospital of Shanxi Medical University from January 2013to October 2021were collected.The local anatomy and course of the patients'cephalic vein were observed through anatomical separation and X-ray fluoroscopy of the guidewire during the implantation of pacing electrodes through thecephalic vein.The results were summarized from three aspects:①Cephalic vein was divided into standard walking cephalic vein and complex walking cephalic vein according to local anatomy.The standard walking cephalic vein was located under the subcutane-ous fat layer and in the interdeltoid groove of the pecto-ralis major.The cephalic vein could be directly exposed by cutting the skin to separate the fat.The complex walking cephalic vein was covered by a muscle layer on he surface of the interdeltoid groove of the pectoralis major,and the surface muscle layer needed to be separated to expose the interdeltoid groove,or accompanied by the muscle layer of the deltoid of the pectoralis major.②Accord-ing to the number of pacemaker electrodes implanted in the operation,the cephalic vein could be divided into:TypeⅠ:2or more pacemaker electrodes could be successfully implanted in the cephalic vein.TypeⅡ:The cephalic vein was thin,and an incision along the cephalic vein was required for placement of a pacing electrode.Type III:The ce-phalic vein was too small to place a pacing electrode.③The presence of variation of the cephalic vein was called the variant walking cephalic vein,including walking across the clavicle on the clavicle,draining into the internal jugular vein,draining into the superior vena cava,located in the thoracic major
关 键 词:心血管病学 头静脉 解剖分型 起搏器植入术 X线曝光时间 手术时间
分 类 号:R318.11[医药卫生—生物医学工程]
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