摘要
目的 评价穿刺胸廓外锁骨下静脉 (ESV)和腋静脉安置永久起搏器电极的方法。 1998年 8月～ 2 0 0 0年 1月 ,共 44例病人 ,男 2 6例 ,女 18例 ,年龄 37～ 82岁 ,病态窦房结综合征 33例 ,Ⅱ°～Ⅲ°房室传导阻滞 11例 ,其中双腔起搏器 2 8例。方法 X线下 ,用 18G针 ,于锁骨下第一肋外 2～ 3cm进针 ,与水平面成 45度 ,针头指向肋锁交界处锁骨下第一肋外缘至内缘间 ;若无回血 ,针头逐步向胸骨侧移动 ,范围 2cm ;针头始终触及第一肋是保证穿刺安全和成功的标志。另采用HP 5 5 0 0型彩色多谱勒血流显像仪 (CDFI)测定 2 5例正常成人ESV和腋静脉内径和解剖位置 ,探查部位在右上胸第一肋和第一肋以下。结果 44例病人共穿刺 47例次均成功 ,其中ESV 46例次和腋静脉 1例次。每例穿刺次数 1～ 5次 ,平均 3次 ;进针深度 2～ 4cm ,平均 2 5cm。经皮穿刺点距锁骨 3～ 4cm ,针头入锁骨下静脉时距锁骨下 0 5～ 1 5cm。一例穿刺入锁骨下动脉 ,无其他并发症。CDFI测定ESV的走行在肋锁交界处第一肋上方 ,位置固定。结论 本方法安全、成功率高 ,避免了锁骨下和头静脉的缺欠和并发症 ,适于安置各种起搏电极。CDFI可指导穿刺ESV。本法远期效果尚待长期观察。
To evaluate the new techniques of puncture of extrathoracic subclavian vein (ESV) and axillary vein for permanent pacemaker implantation In forty-four patients pacing leaders were implanted with this technique, including 28 dual chamber pacemakers Methods 18G needle and 9F introducer were used At 2-3 cm out of subclavian first rib, the needle entered into chest wall with 45° and needle punctured into the vein between the outer and the inter edge of first rib under X-ray It was safe and reliable indication when the needle was advanced and touched the first rib ESV and axillary vein of 25 normal subjects were measured by HP 5500 colour Doppler flow imaging (CDFI) Results In total 47 punctures, 46 were into ESV and one into axillary vein Average puncture time was three with depth 2-4 cm, apart from clavicle 3-4 cm and needle accesses into ESV at 1-1 5 cm out of clavicle without complications, except for only one into artery No any resistance when introducer and leaders were across subclavian vein segment The anatomical location of ESV was fixed Conclusion The methods of puncture across ESV and axillary vein were safe with high successful rate, avoidinjg of defects or complications of puncturing subclavian and cephalic vein, appropriating for all pacemaker leaders CDFI were useful to guide the puncture for pacing leaders
出处
《中国介入心脏病学杂志》
2000年第3期139-140,共2页
Chinese Journal of Interventional Cardiology
关键词
胸廓外锁骨下静脉
腋静脉
超声多谱勒
血流显像
Extrathoracic subclavian vein
Axillary vein
Pacemaker leads
Color Doppler flow imaging
