摘要
目的探索一种补救性紧急心脏起搏的有效方法，并评价其临床应用情况。方法18例住院期间发生心搏骤停或缓慢心率患者，在常规经锁骨下或颈内静脉途径紧急心内膜起搏，但因穿刺静脉未成功或起搏电极未进人右心室，而采取补救性经胸壁环状钢丝紧急心内膜心脏起搏。结果5例心室起搏未夺获心室；其余13例均可起搏夺获心室，未发生心脏压塞的严重并发症。11例患者有效起搏心脏并抢救成功，其中心脏静止3例，心室纤颤经电击除颤后心脏停搏2例，室性心动过速同步电复律后心脏停搏1例，Ⅲ度或高度房室传导阻滞伴极缓慢交界性逸博4例，高血钾伴极缓慢室性心率1例。8例成功夺获心室者心脏停搏至心脏穿刺时间较5例起搏未成功夺获心室者明显缩短[（17．6±4．6）min比（26．4±5．4）min，P〈0．05]。结论环状钢丝电极经胸壁紧急心内膜心脏起搏是一种安全可靠的心脏紧急起搏方法；有助于迅速建立有效的紧急心脏起搏。当常规经静脉途径心脏起搏不成功时，应果断改用经胸壁钢丝电极紧急心内膜心脏起搏，以提高抢救成功率。
Objective To explore an effective method of emergency remedial cardiac pacing and evaluate its clinical application. Methods The transthoraeic cardiac pacing was used by a steel wire loop electrode to 18 patients with cardiac arrest or serious bradycardia, after a routine cardiac pacing was failed by way of jugular or subclavian vein. Results It is a simple procedure used by steel wire lopp. All the pacing had been successfully captured the hearts except 5 cases without capturing. There were 3 cases of cardiac arrest, 2 cases of cardiac arrest after electric defibrillation, 1 case of cardiac arrest after electric shock because of ventricular running and all the 5 cases of severe cardiac bradycardia due to serious atrioventricular block caused by high blood potassium were survived. Eight cases of cardiac arrest were successful capture, that was due to the short period of time from cardiac arrest to ventricle puncture than that of 5 cases of ventricular pacing which was not successful[（17.6 ±4.6） minutes vs. （26.4 ± 5.4） minutes, P 〈 0. 051. Conclusion The steel wire loop electrode is a safe and reliable emergency cardiac pacing method, which contribute to the rapid establishment of an effective emergency cardiac pacing. When the conventional intravenous cardiac pacing was not successful, the method of emergency transthoracic cardiac pacing used by steel wire loop electrode should be bold and use to improve the successful rate of resuscitation.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2010年第2期79-81,共3页
Chinese Critical Care Medicine
基金
广东省科技计划项目（20088030301198）
关键词
心搏骤停
心脏起搏
人工
电极
环状钢丝
Cardiac arrest
Emergency endocardial pacing
Steel wire loop electrode
