Atlee J L, Pattison C Z, Mathews E L, Bilof R M, Hedman A G
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee.
Pacing Clin Electrophysiol. 1992 Oct;15(10 Pt 1):1515-25. doi: 10.1111/j.1540-8159.1992.tb02925.x.
Sinus bradycardia (SB) and atrioventricular junctional rhythm (AVJR) commonly cause circulatory insufficiency in anesthetized surgical patients. Treatment is usually with drugs, which can be ineffective or have adverse effects. Cardiac pacing might be preferred, but the transvenous or epicardial routes are too invasive for routine use, and transcutaneous pacing fails to preserve atrial transport function. Transesophageal atrial pacing (TAP) lacks these disadvantages, yet unavailability of inexpensive products has prevented more widespread use. Therefore, a pacing esophageal stethoscope (PES) fabricated by addition of bipolar electrodes to disposable esophageal stethoscopes routinely used for intraoperative monitoring, was evaluated in 100 anesthetized adults. TAP thresholds (10-msec pulses) and hemodynamic effects of TAP as treatment for incidental SB (< or = 60 beats/min) or AVJR were determined. Minimum TAP thresholds (mean +/- standard error) in 48 males were 7.3 +/- 0.3 mA and in 51 females were 8.5 +/- 0.4 mA. Corresponding inferior alveolar ridge-to-electrode distances were 32.5 +/- 0.2 and 30.4 +/- 0.2 cm. For 48 patients with SB < or = 60 beats/min (54 +/- 1 beats/min), TAP (81 +/- 1 ppm) produced average 15, 11, and 14 mmHg increases in systolic, diastolic, and mean arterial pressure, respectively (P < 0.001). For 11 patients with AVJR (71 +/- 5 beats/min), TAP (92 +/- 3 ppm) produced average 23 and 15 mmHg increases in systolic and mean arterial pressure, respectively (P < 0.05). There were no apparent complications of TAP. TAP with a PES appears practical, safe, and effective for prophylaxis and treatment of SB or AVJR in anesthetized surgical patients.
窦性心动过缓（SB）和房室交界性心律（AVJR）通常会导致麻醉手术患者出现循环功能不全。治疗通常采用药物，但药物可能无效或产生不良反应。心脏起搏可能是更好的选择，但经静脉或心外膜途径侵入性过大，不适合常规使用，而经皮起搏无法保留心房运输功能。经食管心房起搏（TAP）没有这些缺点，但由于缺乏廉价产品，其应用未能更广泛普及。因此，我们对100例麻醉成年患者使用了一种通过在术中监测常用的一次性食管听诊器上添加双极电极制成的起搏食管听诊器（PES）进行评估。测定了TAP阈值（10毫秒脉冲）以及TAP作为治疗偶发性SB（≤60次/分钟）或AVJR时的血流动力学效应。48名男性的最低TAP阈值（平均值±标准误差）为7.3±0.3毫安，51名女性为8.5±0.4毫安。相应的下牙槽嵴到电极的距离分别为32.5±0.2厘米和30.4±0.2厘米。对于48例SB≤60次/分钟（54±1次/分钟）的患者，TAP（81±1次/分钟）使收缩压、舒张压和平均动脉压分别平均升高15、11和14毫米汞柱（P<0.001）。对于11例AVJR（71±5次/分钟）的患者，TAP（92±3次/分钟）使收缩压和平均动脉压分别平均升高23和15毫米汞柱（P<0.05）。TAP没有明显并发症。对于麻醉手术患者，使用PES进行TAP似乎是预防和治疗SB或AVJR的实用、安全且有效的方法。
