Kemnitz J, Peters J
Abteilung für Klinische Anästhesiologie, Heinrich-Heine-Universität Düsseldorf.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1993 Jun;28(4):199-212. doi: 10.1055/s-2007-998909.
Recent developments have changed the techniques and indications for different methods of temporary cardiac pacing. Temporary transvenous pacing involves endocardial right ventricular stimulation by a bipolar electrode, introduced directly via a vein, or through a "paceport" pulmonary artery catheter. A "multipurpose" pulmonary artery catheter permits both atrial and ventricular sensing and pacing. Noninvasive transcutaneous cardiac pacing is safe, fast, and easily applicable. However, pain and discomfort from cutaneous nerve or muscle stimulation may be intolerable for unsedated patients. Transoesophageal cardiac pacing is usually successful only for atrial stimulation, e.g., in sinus node bradycardia, but is not indicated in patients with impaired AV-conduction. In patients with implanted pacemakers, temporary cardiac pacing can both impair or improve the haemodynamic situation. Implanted pacemakers should always be checked following surgery involving electrocautery. Preoperatively, rate-responsive pacemakers should be re-programmed so as to avoid activation of the rate-responsive function. Automatic implantable cardioverter-defibrillators should be deactivated to avoid delivery of inappropriate shocks. In patients with implanted epicardial patch electrodes, transthoracic defibrillation can be difficult with routine defibrillation protocols and may require positioning of the paddles on the lateral chest wall. However, emergency noninvasive transcutaneous cardiac pacing is possible in such patients with normal thresholds.
近期的进展改变了不同临时心脏起搏方法的技术和适应证。临时经静脉起搏是通过双极电极直接经静脉或通过“起搏端口”肺动脉导管进行心内膜右心室刺激。“多功能”肺动脉导管可进行心房和心室感知及起搏。无创经皮心脏起搏安全、快速且易于实施。然而，对于未使用镇静剂的患者，皮肤神经或肌肉刺激引起的疼痛和不适可能难以忍受。经食管心脏起搏通常仅在心房刺激时成功，例如在窦房结心动过缓时，但在房室传导受损的患者中不适用。对于植入起搏器的患者，临时心脏起搏可能会损害或改善血流动力学状况。在涉及电灼的手术后，应始终检查植入的起搏器。术前，应重新编程频率适应性起搏器，以避免激活频率适应性功能。应停用自动植入式心脏复律除颤器，以避免不适当的电击。对于植入心外膜贴片电极的患者，按照常规除颤方案进行经胸除颤可能困难，可能需要将电极板置于侧胸壁。然而，对于阈值正常的此类患者，紧急无创经皮心脏起搏是可行的。
