摘要目的 探讨在需要临时起搏保护的心脏永久起搏器植入术中应用主动起搏导线代替常规临时起搏导线进行临时起搏的可行性和安全性.方法 回顾性分析阜外医院从2016年9月至2019年3月需要在永久起搏器植入术中进行临时起搏保护的三度房室传导阻滞患者90例,根据选用的临时起搏方式分为两组.A组患者(n=40)术前经股静脉穿刺植入临时起搏导线保护,术后撤出临时起搏导线;B组患者(n=50)术中选用2根主动起搏导线,其中1根作为临时起搏导线置于右心室且不旋出螺旋,连接临时起搏器保护,待另1根心室导线到位固定后将临时起搏的导线撤出心室,植入心房.观察两组患者手术时间、围术期并发症、X线曝光时间等.结果 两组患者基线资料相似.术中临时起搏夺获的患者比例两组间差异无统计学意义(83％对84％,P=0.535).B组患者整体手术平均时间小于A组(69 min对81 min,P=0.011),B组临时起搏的X线曝光时间较A组显著缩短(3.2 min对7.1 rmin,P=0.000),曝光量也较A组明显减少(2.1 mGy对3.3 mGy,P=0.029).围术期A组出现股静脉穿刺处血肿2例、动静脉瘘1例.B组无临时起搏相关并发症.A组使用的临时起搏导线和穿刺针鞘为一次性耗材,手术费用增加.结论 应用主动起搏导线代替常规经股静脉临时起搏可节约手术时间,减少X线曝光时间,减少并发症和经济费用,安全可行,是值得推广的一种新方法.

abstractsObjective This study aimed to investigate the feasibility and safety of active-fixation lead for protective temporary cardiac pacing during permanent pacemaker implantation.Methods We retrospectively enrolled 90 severe complete atrioventricular block patients who needed protective temporary pacing during pacemaker implantation from September 2016 to March 2019 in Fuwai Hospital,and patients were classified into 2 groups by protective temporary cardiac pacing strategies.Patients in group A (n=40)received routine temporary pacing through right femoral venous access,and the temporary pacing lead was removed after permanent pacemaker implantation procedure.Patients in group B (n=50) firstly received temporary cardiac pacing by using an active-fixation lead through venous access (axillary or subclavian vein)during routine procedure of permanent pacemaker implantation.After fixation of ventricular lead for permanent ventricular pacing,the first temporary pacing lead was withdrawn and placed for atrial permanent pacing.The total procedural time,perioperative complications,and X ray exposure were compared between the two groups.Results Patients in two groups had similar baseline clinical characteristics.The frequency of patients needing temporary pacing during procedure was comparable between two groups (83％ vs.84％,P=0.535).The average time of total procedure in group B was significantly shorter than that in group A (69 rmin vs.81 min,P=0.011).The exposure time(3.2 min vs.7.1 min,P=0.000)and the exposure doses of X ray (2.1 mGy vs.3.3 mGy,P=0.029) were significantly reduced in groupB as compared with group A.Two cases had hematomas at puncture site of femoral vein and one case had arteriovenous fistula in group A.No perioperative complications were detected in group B.Temporary pacing lead and delivery sheath used in group A increased additional cost as compared to group B.Conclusion Application of active-fixation lead as temporary pacing lead during permanent pacemaker implantation might be a novel approach with improved cost effectiveness reduced time of procedure,and X-ray exposure instead of routine temporary pacing via femoral venous access.