CAJ | 학술논문

目的：观察钢丝电极对活体动物正常心跳情况下心脏穿刺心内膜起搏中起搏参数及心脏的影响，并评价其安全性。方法6只杂种犬麻醉及开胸后，使用环状钢丝电极和钩状钢丝电极分别在右心室相应的4个部位行心脏穿刺心内膜起搏（每只犬各接受8次穿刺），测定每个部位每个电极的有效起搏时间、起搏参数和穿刺并发症（出血时间及出血量）；最终两种电极各完成24次测定操作，比较两组各测定值的差异。结果两组心脏起搏成功率均为100%；环状钢丝电极组有效起搏心脏操作时间稍短于钩状钢丝电极组，但两组比较差异无统计学意义（s：18.4±2.3比19.6±4.1，P＞0.05）；环状钢丝电极组起搏参数如操作时间（s：18.4±2.3比19.6±4.1）、起搏阈值（V：2.1±0.2比2.2±0.8）、R波振幅（mV：11.3±3.2比12.6±4.1）、电极阻抗（Ω：674.2±89.7比668.5±101.3）等与钩状钢丝电极组比较差异均无统计学意义（均P＞0.05）。环状钢丝电极组插入和拔出电极后出血时间〔插入电极后（min）：4.4±2.3比4.5±3.1，拔出电极后（min）：4.1±2.2比4.8±2.5〕、出血量〔插入电极后（mL）：2.8±2.4比3.2±3.5，拔出电极后（mL）：3.3±1.7比3.5±2.6，均P＞0.05〕与钩状钢丝电极组比较差异均无统计学意义（均P＞0.05）。结论在活体动物正常心跳情况下，环状钢丝电极与钩状钢丝电极同样在心脏穿刺心内膜起搏中操作性能和起搏功能均良好，对心脏未产生明显损伤作用，有助于迅速建立有效的紧急心脏起搏。
목적：관찰강사전겁대활체동물정상심도정황하심장천자심내막기박중기박삼수급심장적영향，병평개기안전성。방법6지잡충견마취급개흉후，사용배상강사전겁화구상강사전겁분별재우심실상응적4개부위행심장천자심내막기박（매지견각접수8차천자），측정매개부위매개전겁적유효기박시간、기박삼수화천자병발증（출혈시간급출혈량）；최종량충전겁각완성24차측정조작，비교량조각측정치적차이。결과량조심장기박성공솔균위100%；배상강사전겁조유효기박심장조작시간초단우구상강사전겁조，단량조비교차이무통계학의의（s：18.4±2.3비19.6±4.1，P＞0.05）；배상강사전겁조기박삼수여조작시간（s：18.4±2.3비19.6±4.1）、기박역치（V：2.1±0.2비2.2±0.8）、R파진폭（mV：11.3±3.2비12.6±4.1）、전겁조항（Ω：674.2±89.7비668.5±101.3）등여구상강사전겁조비교차이균무통계학의의（균P＞0.05）。배상강사전겁조삽입화발출전겁후출혈시간〔삽입전겁후（min）：4.4±2.3비4.5±3.1，발출전겁후（min）：4.1±2.2비4.8±2.5〕、출혈량〔삽입전겁후（mL）：2.8±2.4비3.2±3.5，발출전겁후（mL）：3.3±1.7비3.5±2.6，균P＞0.05〕여구상강사전겁조비교차이균무통계학의의（균P＞0.05）。결론재활체동물정상심도정황하，배상강사전겁여구상강사전겁동양재심장천자심내막기박중조작성능화기박공능균량호，대심장미산생명현손상작용，유조우신속건립유효적긴급심장기박。
Objective To observe the parameters and effect of endocardial pacing by steel wire electrode cardiac puncture on heart with normal beat in living animal, and evaluate its safety.Methods After anaesthesia and thoracotomy in 6 living dogs with normal heart beat, the pericardia were excised. Steel wire electrodes with annular or hook tips were used respectively at right ventricular 4 corresponding spots to perform cardiac puncture endocardiac pacing (each dog experienced 8 times of puncture); the time from puncture to effective pacing, pacing parameter and puncture complication (time and quantity of bleeding) of each electrode at each spot were recorded. Finally, the two types of electrode completed 24 times of manipulation respectively; the data collected of the two types were compared. Results The cardiac pacing successful rates in the two groups were 100%; the time taken from the beginning of heart puncture to effective pacing in annular tip group was less than that in hook tip group, but the time difference between the two groups showed no statistical significance (s: 18.4±2.3 vs. 19.6±4.1,P > 0.05). The parameters of pacing in the annular tip group, such as operation time (s: 18.4±2.3 vs. 19.6±4.1), the threshold value of pacing (V: 2.1±0.2 vs. 2.2±0.8), the amplitude of R wave sensed (mV: 11.3±3.2 vs. 12.6±4.1) and the impedance of electrode (Ω: 674.2±89.7 vs. 668.5±101.3) were not significantly different compared with those in the hook tip group (allP > 0.05). Either after puncture or after the electrodes were taken out, the time of bleeding [after puncture (minutes): 4.4±2.3 vs. 4.5±3.1, after the electrodes taken out (minutes): 4.1±2.2 vs. 4.8±2.5] and the volume of bleeding [after puncture (mL): 2.8±2.4 vs. 3.2±3.5, after the electrodes taken out (mL): 3.3±1.7 vs. 3.5±2.6] were not significantly different between the two groups (allP > 0.05).Conclusions In living dogs with normal heart beat, the manipulation and function of endocardiac pacing by cardiac puncture with either steel wire annular or hook tip electrode are well and effective, and the performance is simple and safe without any serious myocardial injury and complication. Thus, it is helpful to quickly establish efficient endocardiac pacing in emergency cases.