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经静脉造影或观察导丝走形证实 6例患者存在静脉畸形、迂曲、狭窄 ,其中 5例高龄患者置入永久起搏器时 ,其上腔静脉系统迂曲、狭窄 ,无法使用起搏器穿刺套装内的导丝及鞘管将导线送到起搏部位 ,另 1例为永存左上腔静脉合并有右上腔静脉缺如。试用 175cm 0 .0 35长导丝以及 6 8FINPUT鞘替代普通起搏器穿刺套装。结果 :使用175cm 0 .0 35长导丝以及 6 8FINPUT鞘顺利地将起搏导线送入右心房中下部 ,安全地完成置入手术 ,无并发症。结论 :一旦送入导线或导丝困难 ,应积极地进行血管造影 ,不应盲目的推送 ,使用 175cm长导丝增加支撑力 ,结合IN PUT鞘管通过狭窄或纡曲延长的血管段 ,给起搏导线提供一个光滑的通道 ,可顺利的将起搏导线送入心房及心室。
Venous angiography or observation of the guide wire to confirm the presence of 6 cases of venous malformations, tortuosity, stenosis, of which 5 cases of elderly patients with permanent pacemaker, the superior vena cava system tortuous, narrow, can not use the pacemaker puncture set The guide wire and sheath within the lead to the pacing site, and the other cases of permanent left superior vena cava with right superior vena cava missing. Try 175cm 0 .0 35 long guidewire and 6 8FINPUT sheath instead of ordinary pacemaker puncture set. Results: The 175 cm 0. 35 long guide wire and 6 8 PFINPUT sheath were used to deliver the pacing lead smoothly to the middle and lower part of the right atrium. The procedure was completed safely and no complications were found. CONCLUSIONS: Angiography should be performed actively once wire or guidewire insertion is difficult, and should not be pushed blindly. Use a 175 cm long guide wire to increase supportive force, in conjunction with an IN PUT sheath through a stenosed or curved extension of the vascular segment, The guidewire provides a smooth passageway for smoothly routing the pacing lead into the atria and ventricles.