目的：探讨超声显像应用于心脏起搏器置入手术的方法和效果。

方法：11例有永久起搏指征的患者中，选用VDD 1例，VVI 6例，VVIR2例，自动夺获型VVI 2例。穿刺左锁骨下静脉插入永久电极，分别取剑突下上下腔静脉长轴切面、剑突下四腔切面、左侧位心尖四腔、胸骨旁四腔切面和剑突下右心室流出道长轴切面反复确认导管尖端经上腔静脉、右心房、三尖瓣口抵达右心室心尖部而非抵达心室间隔中段或右心室流出道并确保导管心房段留有足够弧度。测试验证永久电极的阈值、阻抗、感知性能等参数满意后结扎固定导管，将起搏器与导管牢固连接、埋入胸前皮下囊袋。

结果：11例手术均顺序完成，电极定位指标均满意。经最短3月、最长15月随访，起搏系统工作正常，除1例电极脱位外，无其他并发症。

结论：超声引导下实施心脏起搏，是一项高效、安全、简便、实用和经济的超声介入新技术，可作为X线透视下永久起搏术的替代和补充，采用多切面、动态观察电极尖端走向是定位成功的关键。

Experience in Echocardiography-Guided Permanent Pacemaker Implantation (Abstract)

Department of cardiology, The First Affiliated Hospital, Kunming Medical College, KunMing(650032), Yunnan

guo Tao, Zhao Huai, Gu Yun, et al.

objective: To evaluate the efficiency and safety of two- dimensional echocardiography (2DE) in transvenous pacemaker implantation.

Methods: transvenous pacemaker implantation was performed in 11 patients with bradycardia,2DE was used to locate the endocardiac leads with multisection echoscan and dynamic echoscan during the operation.

Results: procedure success was 11 cases and all of them gained improved quality of life. a lead relocation was performed by X-ray fluoroscopy for the first patient after nine days. No other complication occurred during the procedure and follow- up.

Conclusion: permanent pacemaker implantation by the aid of 2DE is a safe and reliable method with high successful rate and low complication and lower cost, which should be used as an alternative and supplement for the classioal method.