心外膜入路在心脏电生理的应用进展  

Application Progress of Epicardial Approach in Cardiac Electrophysiology

作　　者：刘丁铭 崔凯军[1] 崔馨爱 文俊杰[3] LIU Dingming;CUI Kaijun;CUI Xin’ai;WEN Junjie(Department of Cardiovascular Medicine,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China;Keele Joint Health and Medical Sciences Institute,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,Sichuan,China;Department of Cardiovascular Medicine,Guang’an People’s Hospital,Guang’an 638000,Sichuan,China)

机构地区：[1]四川大学华西医院心血管内科,四川成都610041 [2]成都中医药大学基尔健康医学院,四川成都610075 [3]广安市人民医院心血管内科,四川广安638000

出　　处：《心血管病学进展》2024年第6期494-497,501,共5页Advances in Cardiovascular Diseases

摘　　要：成功进入心外膜间隙是许多心脏手术的基础。既往室性心律失常和心外膜旁道的导管消融,特别是在非缺血性心肌病心外膜室性心动过速基质消融中,经皮剑突下心外膜入路已成为该类室性心律失常的首选治疗策略。随着研究不断深入,经皮剑突下心外膜入路逐步应用于左心耳闭塞、食管保护、膈神经保护、心房颤动的标测和消融、心外膜起搏导线植入等。安全进入心外膜间隙是一项重大挑战。在过去的几年里,针中针技术、经冠状静脉窦或右心耳进行二氧化碳灌注、无对比剂指导下的干性心包穿刺、实时压力/频率监测的心外膜穿刺针等多项技术的进步显著改善了心外膜入路的安全性。基于此,现主要对心包结构、心外膜手术的适应证、常见心外膜入路对患者的影响等进行综述,旨在为未来研究提供参考。Successfully entering the epicardial space is the basis of many cardiac operations.During catheter ablation of ventricular arrhythmias and epicardial accessory pathway especially in matrix ablation of epicardial ventricular tachycardia in non-ischemic cardiomyopathy,percutaneous subxiphoid epicardial approach has become the preferred treatment strategy for these ventricular arrhythmias.With the deepening of research,percutaneous subxiphoid epicardial approach has been gradually applied to left atrial appendage occlusion,esophageal protection,phrenic nerve protection,mapping and ablation of atrial fibrillation,epicardial pacing lead implantation.Safe access to the epicardial space is a major challenge.In the past few years,advances of various technologies,such as needle-in-needle technique,carbon dioxide perfusion through the coronary sinus or right atrial appendage,dry pericardiocentesis without contrast media and epicardial puncture needle for real-time pressure/frequency monitoring have significantly improved the safety of epicardial approach.Based on this,this paper mainly reviews the pericardial structure,the indications of epicardial surgery and the influence of common epicardial approach on patients,in order to provide reference for future research.

关 键 词：心外膜入路 心脏电生理学 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]