CAJ | 학술논문

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。
목적：탐토급성하벽심기경사삼도방실전도조체환자림시기박채용우실류출도간격부기박적가행성、유효성화안전성。방법대본원자2012년9월～2014년7월소수치적27례급성하벽심기경사반삼도방실전도조체환자，상시성천자좌측쇄골하정맥혹자경내정맥，채용주동전겁（골유체1688T라선전겁）행우실류출도간격부림시기박，술중측시기박역치，회병방감호실관찰안전성、기박은정성화도치심률실상발생정황。결과27례환자23례경좌측쇄골하정맥성공식입라선전겁병고정우우실류출도간격부，4례환자좌측쇄골하동맥천자불성공개위우측경내정맥성공식입，기박균정상，종개시천자지라선전겁고정우우실류출도간격부시간위5～9min，라선전겁류치시간위1～5d，무감염、탈위、심장천공화심포전새등상관병발증。결론종본연구결과간，급성하벽심기경사합삼도방실전도조체채용우실류출도간격부기박시가행적，기박은정，불역탈위，가이피면상규심첨부（고근경사배사심기）기박가능도치적심장천공、심포전새등병발증，우기시하벽합병우실심기경사환자。
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 ifxed 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. Conclusions from the Results of this study, acute inferior wall myocardial infarction or third degree atrioventricular block with right ventricular outflow tract interval of pacemaker is feasible, pacemaker is stable, not easy dislocation, can avoid the conventional apex department (near myocardial infarct necrosis) pacemaker can lead to cardiac complications such as perforation, cardiac tamponade, especially under the wall with right ventricular myocardial infarction patients.