Harrigan Richard A, Chan Theodore C, Moonblatt Steven, Vilke Gary M, Ufberg Jacob W
Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
J Emerg Med. 2007 Jan;32(1):105-11. doi: 10.1016/j.jemermed.2006.05.037.
Emergency Department placement of a temporary transvenous cardiac pacemaker offers potential life-saving benefits, as the device can definitively control heart rate, ensure effective myocardial contractility, and provide adequate cardiac output in select circumstances. The procedure begins with establishment of central venous access, usually by a right internal jugular or left subclavian vein approach, although the femoral vein is an acceptable alternative, especially in patients who are more likely to bleed should vascular access become complicated. The indications for the procedure, as well as the equipment needed, are reviewed. Both blind and ECG-guided techniques of insertion are described. Methods of verification of pacemaker placement and function are discussed, as are the early complications of the procedure.
在急诊科放置临时经静脉心脏起搏器可带来潜在的救命益处，因为该装置能够明确控制心率、确保有效的心肌收缩力，并在特定情况下提供足够的心输出量。该操作首先要建立中心静脉通路，通常采用右颈内静脉或左锁骨下静脉入路，不过股静脉也是一种可接受的替代方法，尤其是对于血管通路出现并发症时出血风险较高的患者。本文回顾了该操作的适应证以及所需设备。文中描述了盲插法和心电图引导下的插入技术。讨论了起搏器放置及功能验证的方法，以及该操作的早期并发症。
