摘要
目的阐释心包穿刺过程中的电学特点并探讨一种不依赖X线的三维心包穿刺新技术的有效性和安全性。方法以健康家猪为实验动物,在三维电解剖标测系统指导下用Smart Touch压力导管三维重建左右心室,随后用Carto Sound超声导管重建心外膜外壳。将心包穿刺针或者导丝设置为一个电极并连接于三维电解剖标测系统,观察三维心包穿刺过程中的空间特点,同时通过针尖上的单极电图,观察三维心包穿刺过程中的电学特点。结果13只实验猪均成功完成了心包穿刺,在三维系统上不仅能够准确显示穿刺针的移动,也能够显示导丝的移动。纵隔电位(3.2±1.1)m V,心包外膜电位(4.8±1.5)m V,心外膜电位(9.6±2.6)m V,两两比较差异均有统计学意义(均P<0.05)。3只实验猪尝试2次或以上穿刺成功,其余均为第1次穿刺成功。8只实验猪短暂使用X线,X线透视时间(43±25)s,5只全程没有使用射线。术中急性心包渗血4只,但均没有心脏压塞表现,术后观察24 h均无心包渗血。结论心外膜、心包以及相邻纵隔的电位变化具有特征性,电学指导下三维心包穿刺不仅安全有效,还是一种不依赖X线的技术。
Objective To explain the electrographic characteristics of epicardial access( EA) and discuss the effectiveness and safety of a new technique of three-dimensional pericardial puncture that does not depend on X-rays. Methods Thirteen healthy domestic pigs were used as experimental animals. Under the guidance of three-dimensional electroanatomical mapping( EAM) system,the left and right ventricles were reconstructed with Smart Touch catheter,and then the epicardium shell was reconstructed with Carto Sound catheter in healthy pigs.The EA needle or guidewire was set as an electrode and connected to the EAM system to observe the spatial characteristics during the three-dimensional EA. at the same time,the electrographic characteristics during the EA process through the monopolar electrogram on the needle tip was observed. Results EA was successfully completed in all the 13 pigs. In the three-dimensional EAM system,the movement of the puncture needle can be accurately displayed and the movement of the guide wire can be displayed. The mediastinum potential was( 3. 2 ± 1. 1) m V,epicardial potential was( 4. 8 ± 1. 5) m V,epicardial potential was( 9. 6 ± 2. 6) m V,and there were significant differences( all P < 0. 05). Three experimental animals were successfully punctured twice or more,and the rest were successfully punctured for the first time. Eight experimental pigs were examined by X-ray,X-ray fluoroscopy time was( 43 ± 25) s,5 cases did not use X-ray. There were 4 cases of acute pericardial bleeding during the operation,but there was no cardiac tamponade,there was no pericardial bleeding at 24 h after operation. Conclusion The potential changes of epicardium,pericardium and adjacent mediastinum are characteristic. Three-dimensional EA under the guidance of electrography is safe and effective,which is also a technique independent of X-ray.
作者
喻荣辉
赵欣
王伟
孙云
彭亚军
王毅
朱研
田龙云
李佳瑶
蒋晨曦
刘念
白融
马长生
Yu Ronghui;Zhao Xin;Wang Wei;Sun Yun;Peng Yajun;Wang Yi;Zhu Yan;Tian Longyun;Li Jiayao;Jiang Chenxi;Liu Nian;Bai Rong;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Wuhan Greenovo Biotechnology Co.,Ltd.,Wuhan 430075,China;Johnson&Johnson(Shanghai)Medical Devices Co.,Ltd.,Shanghai 200052,China)
出处
《中国医药》
2020年第5期641-644,共4页
China Medicine
基金
北京市科技计划(Z181100001718174)。
关键词
心律失常
心包穿刺
三维
无射线
Arrhythmia
Epicardial access
Three-dimension
Fluoroscopy-free
