Lipton M J, Ream A K, Hyndman B H
Circulation. 1978 Dec;58(6):1190-5. doi: 10.1161/01.cir.58.6.1190.
A 60 Hz current, as small as 20 microamperemeter (rms) is capable of causing ventricular fibrillation when directly applied to the heart. Significant cost and engineering effort has been spent to construct monitoring equipment which satisfies the safety regulations requiring maximum leakage currents below this value. Patients undergoing cardiac catheterization are particularly at risk from electrical hazards, primarily because catheters are made from nonconductive materials. A conductive catheter should allow externally applied currents to leak through its walls before reaching the catheter tip. A new electrically conductive catheter was compared with a standard nonconductive catheter. Five dogs were studied, with 81 attempts to cause fibrillation. Sixty-hertz voltage between the catheter and an external electrode was increased until fibrillation occurred or 130 V was reached. Eight states were studied in randomized sequence: conductive or nonconductive catheter, guidewire or saline-filled and tip touching wall, or free in left ventricle (verified by fluoroscopy and cineangiography). The saline-filled and conductive catheter was safer in that fibrillation never occurred, while fibrillation nearly always occurred with the nonconductive catheter. A conductive guidewire negates the protection of the conductive catheter. The application of conductive catheters could reduce instrumentation costs in laboratories and intensive care units and improve patient safety.
60赫兹的电流,只要有效值小至20微安,直接作用于心脏时就能够引发心室颤动。为了构建符合安全规定(要求最大漏电流低于此值)的监测设备,已经投入了大量成本和工程力量。接受心脏导管插入术的患者尤其容易受到电气危害,主要原因是导管由非导电材料制成。导电导管应能使外部施加的电流在到达导管尖端之前通过其壁泄漏出去。将一种新型导电导管与标准非导电导管进行了比较。对5只狗进行了研究,共进行了81次引发颤动的尝试。增加导管与外部电极之间的60赫兹电压,直至发生颤动或达到130伏。按随机顺序研究了8种状态:导电或非导电导管、导丝或充满盐水且尖端接触壁面,或在左心室内自由放置(通过荧光透视和血管造影术验证)。充满盐水的导电导管更安全,因为从未发生颤动,而非导电导管几乎总会引发颤动。导电导丝会抵消导电导管的保护作用。导电导管的应用可以降低实验室和重症监护病房的仪器成本,并提高患者安全性。