2020 年第 5 期 第 15 卷

无射线三维心包穿刺技术的有效性与安全性分析

Study on the feasibility of fluoroscopy-free three-dimensional epicardial access

作者：喻荣辉1赵欣1王伟1孙云2彭亚军2王毅2朱研3田龙云3李佳瑶3蒋晨曦1刘念1白融1马长生1

英文作者：Yu Ronghui1 Zhao Xin1 Wang Wei1 Sun Yun2 Peng Yajun2 Wang Yi2 Zhu Yan3 Tian Longyun3 Li Jiayao3 Jiang Chenxi1 Liu Nian1 Bai Rong1 Ma Changsheng1

单位：1首都医科大学附属北京安贞医院心内科100029；2武汉奥绿新生物科技股份有限公司430075；3强生（上海）医疗器材有限公司200052

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Wuhan Greenovo Biotechnology Co. Ltd. Wuhan 430075 China; 3Johnson & Johnson (Shanghai) Medical Devices Co. Ltd. Shanghai 200052 China

关键词：心律失常；心包穿刺；三维；无射线

英文关键词：Arrhythmia；Epicardialaccess;Three-dimension;Fluoroscopy-free

• 摘要：

• 目的 阐释心包穿刺过程中的电学特点并探讨一种不依赖X线的三维心包穿刺新技术的有效性和安全性。方法 以健康家猪为实验动物，在三维电解剖标测系统指导下用SmartTouch压力导管三维重建左右心室，随后用CartoSound超声导管重建心外膜外壳。将心包穿刺针或者导丝设置为一个电极并连接于三维电解剖标测系统，观察三维心包穿刺过程中的空间特点，同时通过针尖上的单极电图，观察三维心包穿刺过程中的电学特点。结果 13只实验猪均成功完成了心包穿刺，在三维系统上不仅能够准确显示穿刺针的移动，也能够显示导丝的移动。纵隔电位（3.2±1.1）mV，心包外膜电位（4.8±1.5）mV，心外膜电位（9.6±2.6）mV，两两比较差异均有统计学意义(均P＜0.05)。3只实验猪尝试2次或以上穿刺成功，其余均为第1次穿刺成功。8只实验猪短暂使用X线，X线透视时间（43±25）s，5只全程没有使用射线。术中急性心包渗血4只，但均没有心脏压塞表现，术后观察24 h均无心包渗血。结论  心外膜、心包以及相邻纵隔的电位变化具有特征性，电学指导下三维心包穿刺不仅安全有效，还是一种不依赖X线的技术。

  
  

• Objective  To explain the electrographic characteristics of epicardial access（EA） and discuss the effectiveness and safety of a new technique of three-dimensional pericardial puncture that does not depend on X-rays. Methods  Thirteen healthy domestic pigs were used as experimental animals. Under the guidance of three-dimensional electroanatomical mapping (EAM) system, the left and right ventricles were reconstructed with SmartTouch catheter, and then the epicardium shell was reconstructed with CartoSound catheter in healthy pigs. The EA needle or guidewire was set as an electrode and connected to the EAM system to observe the spatial characteristics during the three-dimensional EA. at the same time, the electrographic characteristics during the EA process through the monopolar electrogram on the needle tip was observed. Results  EA was successfully completed in all the 13 pigs. In the three-dimensional EAM system, the movement of the puncture needle can be accurately displayed and the movement of the guide wire can be displayed. The mediastinum potential was （3.2±1.1）mV, epicardial potential was （4.8±1.5）mV, epicardial potential was （9.6±2.6）mV, and there were significant differences(all P＜0.05). Three experimental animals were successfully punctured twice or more, and the rest were successfully punctured for the first time. Eight experimental pigs were examined by X-ray，X-ray fluoroscopy time was (43±25)s, 5 cases did not use X-ray. There were 4 cases of acute pericardial bleeding during the operation, but there was no cardiac tamponade, there was no pericardial bleeding at 24 h after operation. Conclusion The potential changes of epicardium, pericardium and adjacent mediastinum are characteristic. Three-dimensional EA under the guidance of electrography is safe and effective, which is also a technique independent of X-ray.