急性下壁心肌梗死伴三度房室传导阻滞患者采用右室流出道间隔部起搏27例的探讨.docVIP

急性下壁心肌梗死伴三度房室传导阻滞患者采用右室流出道间隔部起搏27例的探讨 　　【摘要】目的 探讨急性下壁心肌梗死三度房室传导阻滞患者临时起搏采用右室流出道间隔部起搏的可行性、有效性和安全性。方法 对本院自2012年9月～2014年7月所收治的27例急性下壁心肌梗死伴三度房室传导阻滞患者，尝试性穿刺左侧锁骨下静脉或者颈内静脉，采用主动电极（圣犹达1688T螺旋电极）行右室流出道间隔部临时起搏，术中测试起搏阈值，回病房监护室观察安全性、起搏稳定性和导致心律失常发生情况。结果 27例患者23例经左侧锁骨下静脉成功植入螺旋电极并固定于右室流出道间隔部，4例患者左侧锁骨下动脉穿刺不成功改为右侧颈内静脉成功植入，起搏均正常，从开始穿刺至螺旋电极固定于右室流出道间隔部时间为5～9min，螺旋电极留置时间为1～5d，无感染、脱位、心脏穿孔和心包填塞等相关并发症。结论 从本研究结果看，急性下壁心肌梗死合三度房室传导阻滞采用右室流出道间隔部起搏是可行的，起搏稳定，不易脱位，可以避免常规心尖部（靠近梗死坏死心肌）起搏可能导致的心脏穿孔、心包填塞等并发症，尤其是下壁合并右室心肌梗死患者。 　　【关键词】急性下壁心肌梗死；房室传导阻滞；临时起搏；主动电极 　　【中图分类号】R541 【文献标识码】A 　　Dai Zhentao Wang Peizhuo Pan Shuhong Yin Hang Zhao Lei 　　（Cangzhou Peoples Hospital ， Cangzhou Hebei 061000 China） 　　【Abstract】Objective Explore acute inferior wall myocardial infarction （mi） for three degree atrioventricular block used temporary pacemaker in patients with right ventricular outflow tract interval of feasibility， effectiveness and safety of pacemaker. Methods in our hospital from September 2012 to July 2014 were 27 cases of acute inferior wall myocardial infarction patients with third degree atrioventricular block with， tentative puncture of left subclavian vein or internal jugular vein， the active electrode （st Jude 1688 t spiral electrode） line of right ventricular outflow tract interval temporary pacemaker， intraoperative test to pacing threshold， back to the ward care unit to observe the safety， stability and cause arrhythmia pacemaker is happening. Results 23 cases by the left subclavian vein 27 patients successfully implanted with screw electrode and the fixed in right ventricular outflow tract interval， the left subclavian artery puncture is not successful in 4 patients to the right internal jugular vein implants， pacemaker are normal， from the beginning puncture to spiral electrode fixed in right ventricular outflow tract interval time is 5 ～ 9 minutes， spiral electrode indwelling time of 1～5 days， no infection， dislocation， heart， perforation and cardiac tamponade and related complications. Concl