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目的探讨二维超声(two-dimensional echocardiography,2-DE)在心脏起搏器植入术中的应用价值。方法选择有心脏起搏器植入指征的患者36例,分为A组(n=18)和B组(n=18)分别应用二维超声引导起搏器植入和X线透视(X-ray fluoroscopy,X-ray)常规方法植入起搏器。两种方法引导起搏电极到位后测试起搏参数满意后结扎固定导管,将起搏器与导管牢固连接。记录电极导管植入到位时间、X线曝光时间、随访观察起搏效果、感染、出血等并发症,两组进行比较。结果A组全部由2-DE引导成功16例(16/18),2-DE和X-ray联合引导成功1例(1/18),1例肺气肿病人超声透声条件极差整个手术过程均改为X-ray引导完成(1/18),总成功率94.4%,(P>0.05)。总暴光时间A组和B组分别为0.8±0.1min和3.0±0.7min(P<0.01)。电极导管植入时间A组、B组分别为9.0±0.7和8.3±0.5min(P>0.05)。结论二维超声可有效引导实施心脏起搏,联合X线透视可提高手术成功率,可明显降低X线曝光时间,减少对医患辐射的危害,可作为心脏起搏器新的植入途径,具有较好的临床应用前景。
Objective To investigate the value of two-dimensional echocardiography (2-DE) in cardiac pacemaker implantation. Methods Thirty-six patients with indications of pacemaker implantation were divided into two groups: group A (n = 18) and group B (n = 18) -ray fluoroscopy, X-ray) implantation of pacemaker. Two methods to guide the pacemaker electrode in place after the test of pacing parameters satisfied with the ligation of the fixed catheter, the pacemaker firmly connected with the catheter. The recording time of lead implantation, X-ray exposure time, follow-up observation pacing effect, infection, bleeding and other complications, the two groups were compared. Results In group A, 16 cases (16/18) were successfully guided by 2-DE and 1 case (1/18) was successfully guided by 2-DE and X-ray. One case of emphysematous patients had poor sonotransmission sound condition. The process was changed to X-ray guide completed (1/18), the total success rate of 94.4%, (P> 0.05). The total exposure time was 0.8 ± 0.1 min in group A and 3.0 ± 0.7 min in group B (P <0.01). The time of lead implantation in group A and group B was 9.0 ± 0.7 and 8.3 ± 0.5 min, respectively (P> 0.05). Conclusion Two-dimensional ultrasound can effectively guide the implementation of cardiac pacing, combined with X-ray fluoroscopy can improve the success rate of surgery, can significantly reduce the X-ray exposure time and reduce the risk of radiation to patients, as a new pacemaker implantation, Has good clinical application prospects.