急诊床旁保护性临时心脏起搏40例观察

目的研究急诊床旁临时起搏电极导线经股静脉植入的安全性、可行性及疗效。方法选择2005年3月至2010年2月中国人民解放军第九二医院心内科ICU住院及急诊科就诊的严重心动过缓患者40例，男26例，女14例，平均36～79岁，平均（67±18．7）岁。全部患者均在非透视条件下急诊床旁经股静脉植入临时起搏电极导线。住院患者临时起搏器正常起搏后，摄床旁X线片观察起搏电极导线尖端位置。转运至上级医院者在透视下查看电极尖端位置。结果40例患者行临时起搏均取得成功，成功率100％。植入临时起搏电极导线所花时间5～18min，平均（11．5±4．3）min。无一例出现静脉内血栓、心肌穿孔、术区感染及其他穿刺局部并发症。结论在非透视条件下临时起搏电极导线经股静脉临时心内膜起搏心脏，安全、便捷、可行、成功率高。适合于急诊床旁临时起搏，避免因患者病情危重，搬动造成生命危险，保护了永久起搏器人路及术区，为患者转运创造条件，挽救了患者生命。

Clinical Observation of 40 Cases of Emergency Bedside Protective Temporary Cardiac Pacing

Objective To explore the safety, feasibility and efficacy of emergency bedside tem- porary pacing wire electrodes implanted via femoral veins. Methods Forty patients with severe bradycardia （26 men, 14 women） aged （67±18.7） years （range,36-79 years） were selected from March 2005 to February 2010 in departments of cardiology and emergency, and emergency bedside temporary pacing wires were introduced via femoral veins in these patients under non-perspective conditions. After pacing, routine chest X-ray was performed to observe the location of pacemaker electrode tip,which was determined by perspective view in higher level hospitals. Results Tern porary pacing was successful in all patients,with a success rate of 100%. The time spent in placing temporary pacing wires averaged （11.5±4.3） minutes （range,5-18 minutes）. None of these patients had venous thrombosis, myocardial perforation, puncture site infection or other local com- plications. Conclusion Under non-perspective conditions, temporary pacing wire electrodes implanted via femoral veins is safe, convenient and feasible with a high success rate for emergency bedside temporary pacing, which can avoid life-threatening because of transportation, protect the puncture site and the approach to permanent pacemaker implantation and create the advantage conditions to save lives of transfer patients.