足位透视角度下腋静脉穿刺术在起搏器植入术中的应用
Safety and feasibility of axillary vein puncture under foot perspective in pacemaker implantation
胡淼阳 1马艺波 1郭兰燕 1张学丹 1闫群 1杜泓宇 1刘兵1
作者信息
- 1. 空军军医大学第一附属医院心脏内科,西安 710032
- 折叠
摘要
目的 通过足位透视角度指导腋静脉穿刺,探索1种减少并发症、降低穿刺难度、提高成功率的改良的穿刺方法.方法 本文为队列研究.回顾性收集2019年1月至2022年12月在空军军医大学第一附属医院心脏内科经静脉植入或升级心血管植入型电子器械的患者.根据采用腋静脉穿刺方法的不同,分为腋静脉组(97例)和常规组(1515例),采用1:1倾向性评分配比法对两组进行匹配,获得常规组(97例).腋静脉组采用足位透视角度观察第1肋骨及胸廓外缘,指导穿刺腋静脉植入起搏导线.常规组采用盲法腋静脉穿刺植入起搏导线.观察和对比两组穿刺相关并发症、穿刺成功率及穿刺相关技术参数.结果 腋静脉组共纳入97例患者,其中男64例(66％,64/97),年龄(60.42±15.23)岁,体重指数(24.57±4.71)kg/m2.常规组纳入97例,其中男66例(68％,66/97),年龄(59.92±10.92)岁,体重指数(24.70±2.66)kg/m2.腋静脉组96例单侧(左侧)穿刺成功,单侧成功率98.97％,总成功率100％.穿刺时平均足位透视角度(35.66±6.84)°,与体重指数无统计学相关性(r=-0.181,P=0.077).未发生血气胸、穿刺点血肿等穿刺相关并发症.发生率低于常规组[0对5.15％(5/97),P=0.059].结论 足位透视角度观察第1肋骨及胸廓外缘指导的腋静脉穿刺法是1种安全、有效、易行的穿刺方法.
Abstract
Objective To explore an improved axillary vein puncture method guided by the caudal fluoroscopic view,in order to reduce complications and the difficulty of puncture,improve the success rate.Methods This was a retrospective cohort study.Patients who underwent implantation or upgrade of cardiac implantable electronic devices via intravenous approach in the Department of Cardiology of The First Affiliated Hospital of Air Force Medical University from January 2019 to December 2022 were retrospectively analyzed.According to puncturation method,patients were divided into the axillary vein group(97 patients)and the control group(1515 patients).The two groups were matched used 1:1 propensity assessment ratio,obtained control group(97 patients).The first rib and the outer edge of the thorax were observed by the caudal fluoroscopic view to guide the puncture of the axillary vein to implant the pacing leads.The control group used blind axillary vein puncture to implant the pacing leads.The puncture related complications,success rate and puncture related technical parameters of the two groups were analyzed.Results A total of 97 patients were included in the axillary vein group,there were 64(66％,64/97)patients were male,the mean age was(60.42±15.23)years,and the mean body mass index was(24.57±4.71)kg/m2.A total of 97 patients were included in the control group,there were 66(68％,66/97)patients were male,the mean age was(59.92±10.92)years,and the mean body mass index was(24.70±2.66)kg/m2.The axillary vein puncture method guided by the caudal fluoroscopic view inunilateral(left)puncture was successful in 96(98.97％)cases,the total success rate was 100％.The average caudal fluoroscopic view during the puncture was(35.66±6.84)°,which was not statistically correlated with body mass index(r=-0.181,P=0.077).No puncture related complications such as pneumothorax,hemothorax and puncture site hematoma occurred.The incidence of complications was lower than that of the control group[0 vs.5.15％(5/97),P=0.059].Conclusion The axillary vein puncture method guided by the caudal fluoroscopic viewis a safe,effective and easy method.
关键词
腋静脉/穿刺术/透视/心血管植入型电子器械/并发症Key words
Axillary vein/Puncture/Fluoroscopy/Cardiac implantable electronic device/Complication引用本文复制引用
出版年
2024
NETL
NSTL
万方数据