新的盲法腋静脉穿刺(“两点两线”法)与锁骨下静脉穿刺在心脏植入装置植入手术中的对比研究  

A comparative study of new blind axillary vein puncture(the"two points and two lines")method and subclavian vein puncture in implantation of cardiae implantable electronic device

作　　者：张艺民 陈梦娜 史婧 张旭 戈晓珍 张俊蒙 ZHANG Yi-min;CHEN Meng-na;SHl jing;ZHANG Xu;GE Xiao-zhen;ZHANG Jun-meng(Department of Cardiology,The First Hospital of Tsinghua University,Beijing 100016,China;Department of Cardiology,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100022,China)

机构地区：[1]清华大学第一附属医院心内科,北京100016 [2]清华大学附属垂杨柳医院心内科,北京100022

出　　处：《中国心脏起搏与心电生理杂志》2024年第4期273-276,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 通过与锁骨下静脉穿刺进行对照研究,探讨新的盲法腋静脉穿刺技术(“两点两线”法)在心脏植入装置植入手术中的可行性与安全性。方法 根据《2013 ESC心脏起搏和心脏再同步化治疗指南》植入指征入选接受心脏植入装置植入患者(年龄≥18岁),分为腋静脉组与锁骨下静脉组,分别采用新的盲法腋静脉穿刺法(“两点两线”法)和锁骨下静脉穿刺法建立血管通路并置入起搏导线。比较两种穿刺方法的成功率、穿刺次数、穿刺时间和并发症发生率。盲法腋静脉穿刺法首先确定沿肌间沟走行的A线,再确定与之平行的B线,最后在B线上确定穿刺点,在操作过程中记录腋静脉穿刺进针角度α、β。结果 共纳入90例患者,其中男性50例,年龄(74.61±12.29)岁,其中腋静脉组45例,锁骨下静脉组45例。两组穿刺成功率分别为93.3%和95.6%;两组穿刺成功所需次数分别为(1.35±0.66)次和(1.30±0.64)次,两组穿刺成功所需时间分别为(44.5±15.8)s和(46.1±15.3)s,两组并发症发生率分别为4.5%和6.7%,两组间成功率、穿刺成功所需次数、穿刺成功所需时间及并发症发生率无差异(P>0.05)。腋静脉穿刺进针角度α为(25.79±3.95)°,进针角度β为(65.02±9.14)°。结论 新的盲法腋静脉穿刺法(“两点两线”法)在心脏植入装置植入手术中是安全可行的。Objective To compare the feasibility and safety of new blind axillary vein puncture(the"two points and two lines")method and subclavian vein puncture for implantation of cardiac implantable electronic device.MethodsAccording to the 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy,patients(aged≥18 years)undergoing cardiac implantable electronic device implantation were divided into axillary vein group and subclavian vein group.The new bland axillary vein puncture-the"two points and two lines"method and subclavian vein puncture were used to establish vascular access respectively.To compare the succes rate,number of successful puncture,puncture time and complication of two kinds of puncture technique.In the process of axillary vein puncture,line A along the intermuscular groove was first determined,then the line B parallel to line A was determined,and the puncture point was finally determined on line B,and the insertion angle α and β were recorded.Results A total of 90 patients were enrolled,including 50 males,with an average age of(74.61±12.29)years,including 45 in the axillary vein group and 45 in the subclavian vein group.The rate of success in two groups were 93.3%and 95.6%;The number of successful puncture in two groups were(1.35±0.66)times and(1.30±0.64)times;The mean puncture time in two groups were(44.5±15.8)s and(46.1±15.3)s;The incidence of complication in two groups were 4.5%and 6.7%.Two groups of patients had no significant difference in successful puncture rate,number of successful puncture,puncture time and complication incidence rate(P>0.05).The injection angleαwas(25.79±3.95)°,and the angleβwas(65.02±9.14)°.Conclusion It is safe and feasible for the implantation of cardiac implantable electronic device by the new bland axillary vein puncture-the"two points and two lines"method.

关 键 词：心血管病学 腋静脉 锁骨下静脉 心脏植入装置 

分 类 号：R318.11[医药卫生—生物医学工程]