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目前,永久性人工心脏起搏器安置术都采用经静脉插入心内膜起搏电极法,其技术关健是起搏导管电极的安插和定位。本文介绍1983年以来作者为183例患者安插永久性右室心内膜起搏电极无1例发生电极脱位、心肌穿孔和导管断裂的粗浅体会。一、导管插入静脉径路的选择目前,比较统一的看法是首选头静脉。本组预选142例,成功118例。头静脉解剖位置恒定,体表标志明确,导管埋藏较深,局部较固定,电极不易因肢体活动牵拉脱位,又可在同一切口内安插电极导管及埋藏起搏器。我们一般取左锁骨中卢下1～2cm处向外延伸作水平切口长4～5cm,切口外缘达胸大肌和三角肌的肌间沟。沿肌间沟作斜形切口,虽有利于头静脉暴露,但影响术侧上肢的早期活动。在分离头静脉时,动作应轻柔,避免过多刺激后静脉收缩使导管难以插入。少散病人在导管插入头静脉约5～10cm处受阻,多半
At present, the permanent artificial pacemaker placement are adopted intravenous endocardial pacing electrode method, the technical key point is pacing catheter electrode placement and positioning. This article describes the author since 1983, 183 patients with permanent right ventricular endocardial pacing electrode implantation in 1 case without electrode dislocation, myocardial perforation and catheter rupture of the superficial experience. First, the choice of catheters into the vein path Currently, a more unified view is the preferred head vein. This group of pre-selected 142 cases, 118 cases of success. Head vein anatomical location, body surface markers clear, deep buried catheter, the local fixed, the electrode is not easy to pull out the limbs due to dislocation, but also in the same incision with the placement of lead and buried catheter pacemaker. We generally take the left supraclavicular lobe 1 ~ 2cm outward extension of the horizontal incision length 4 ~ 5cm, incision edge reached the pectoralis major and deltoid muscle ditch. Oblique incision along the interosseous ditch, although conducive to the cephalic vein exposure, but affects the early activities of the operative side of the upper limb. In the separation of the first vein, the action should be gentle to avoid excessive stimulation of the venous contraction catheter difficult to insert. Fewer patients in the catheter inserted into the cephalic vein about 5 ~ 10cm blocked, mostly