摘要
目的评价3种不同的定位方法穿刺腋静脉置入起搏电极的安全性和实用价值。方法腋静脉组72例,术中用造影剂、导丝定位或透视下直接穿刺腋静脉植入电极;另选性别、年龄与之匹配的72例经锁骨下静脉植入电极的患者作对照组。结果72例患者穿刺腋静脉均获成功,与对照组比较穿刺次数和耗时相似。用造影剂定位穿刺最容易成功,其次为用导丝定位穿刺,直接在透视下解剖定位的穿刺次数和耗时稍高于前2种方法。结论造影剂和导丝定位下穿刺腋静脉成功率高,耗时短,但费用高、烦琐、增加患者痛苦。在透视下以骨性标志定位直接穿刺腋静脉方法安全、简便,成功率高,随着经验的增加可取代造影剂、导丝定位和锁骨下静脉穿刺,以避免锁骨下静脉穿刺的缺点和并发症,可作为常规方法。
Objectives To evaluate the safety and utility of three different kinds of venipuncture to axillary vein for permanent pacemaker implantation. Methods In 72 patients pacing leaders were implanted with the techniques,including 16 patients with intravenous injection of contrast agent to locating the axillary vein, 18 patients with venipuncture through cubital vein introducing guide wire to superior vena cava, pucturing axillary vein directed by the guide wire under X ray, 38 patients punctured by the mark between clavicle and first rib under X ray （a line extending inclined up 10 degree from the middle point in sternoelavicular joint crossing first rib, the crossing point was the one that needle entered into the vein）. 72 patients with the method of pereutaneous venipuncture to subclavian vein as control group. Results All venipunctures to axillary vein were successful in 72 patients, the times and the time consuming of venipuneture were similar to the control （all P〉0. 05）. The easiest way was the one guided by contrast agent locating the axillary vein,average puncture time was 1.2 min, the next was guide wire way, average puncture time was 2.7 min,then the way according the mark between clavicle and first rib under X ray,average puncture time was 3.5 min. Conclusion The way of puncture into the axillary vein is easier by contrast agent or guide wire locating the axillary vein, but more complex. The methods of puncture axillary vein under X ray is safe and reliable with high successful rate and avoiding of defects or complications of puncturing subclavian vein,appropriating for all pacemaker leaders. The way of guide wire or contrast agent locating axillary vein is expense and potential hazard to patients, though with high successful rate.
出处
《重庆医学》
CAS
CSCD
北大核心
2009年第17期2203-2204,共2页
Chongqing medicine
关键词
腋静脉
人工心脏起搏器
起搏电极
axillary vein
artificial pacemaker
pacemaker electrod
