WO2000018470A1 - A fast bedside temporary pacemaker and method of using it - Google Patents

Abstract

A fast bedside temporary pacemaker and method of using it are disclosed, the pacemaker comprising a J-shape lead-in sheath and a false body conduit and four elastic soft electrodes which are matched with an inner passage inside the lead-in sheath, the J-shape lead-in sheath having a J-shape elbow section at the far end and a wire combining section at the electrode near end having a central cavity into which elastic wire can be plugged.

Description

 FIELD OF THE INVENTION The present invention relates to a medical device, and more particularly to a device for rapid bedside temporary cardiac pacing without X-ray guidance and a method of using the same.

Background technique

 Temporary cardiac pacing is an emergency treatment technique for critical illnesses such as severe sinus bradycardia, sinus atrial block, sinus arrest, atrioventricular block, ventricular arrest, etc. These conditions can be seen in acute myocarditis, cardiomyopathy, myocardial infarction, drug poisoning or improper application. The concept of temporary cardiac pacing means that the pacemaker itself is placed outside the body, and only the pacing electrode catheter is inserted into the heart cavity through the vein to make contact with the endocardium; or in vitro non-invasive cardiac pacing, the pacing pulse generator and electrode pads are placed Non-invasive cardiac pacing in vitro, such as Zoll's. At present, there are many methods and approaches for temporary cardiac pacing. Among them, transendocardial pacing and non-invasive non-invasive cardiac pacing are the most versatile, reliable, and widely accepted methods. The advantages of Zo l l non-invasive cardiac pacing in vitro are simple, non-invasive, easy to learn, and can be used for pacing after the electrode pads are attached to critically ill patients. Therefore, it is suitable for universal application. However, this method can not be tolerated in awake patients, and some patients are not effective. It is only applicable to patients who are critically ill and can only maintain a short pacing time. Transvenous endocardial pacing is a widely accepted method of pacing by doctors and patients. Pacing therapy can be maintained for a long time. The effect is reliable and widely accepted. Patients can carry an external pacemaker around the ward. The electrode catheter displacement rate in the method is high, and the incidence of ventricular perforation is about 5%-8%. The infection and pulmonary embolism are higher than the supraclavicular approach when the femoral vein approach is used. Transvenous endocardial pacing without X-ray guidance is difficult, especially when using the femoral vein approach.

Currently, all emergency temporary cardiac pacing methods and approaches are flawed. Insert a standard pacing electrode catheter for transvenous temporary cardiac pacing, and in most cases requires skilled catheterization Pointing technique and X-ray imaging. Transthoracic puncture of the myocardium or endocardium is dangerous and unreliable. The effect of floating electrode catheter for cardiac pacing is also unreliable. In order to access the heart cavity, an electrode catheter with a balloon attached to the top and a pressure monitoring device are needed, or a unipolar endocardial ECG guide is recorded.

 Atrioventricular double-chamber physiological temporary cardiac pacing usually uses two electrode catheters of the atrium and ventricle, which are completed under the guidance of X-rays. The operation steps are cumbersome and require skilled techniques. Atrioventricular dual-chamber physiological cardiac pacing using a single electrode catheter has emerged, but the pacing function is limited to

VDD, the actual DDD function is not implemented.

Summary of the Invention

 The purpose of the present invention is to overcome the above-mentioned shortcomings and deficiencies of the prior art, and to provide a double-chamber physiological temporary cardiac lift device that is simple, safe, and reliable, and can be quickly completed by the bed without X-ray guidance. Instructions.

The object of the present invention is achieved by the following technical solution: A rapid bedside temporary cardiac pacing device, which includes: a T-shaped introduction sheath 1 and a prosthetic catheter 2 inserted into the inner channel 51 of the J-shaped introduction sheath 1 And quadrupole elastic soft electrode 4, the J-shaped introduction sheath 1 has a circular tube shape, and has a distal end 5, a body part 10, and a proximal end 8, and a hemostatic valve 9 is installed in the inner hole of the proximal end 8, and the distal end of the J-shaped introduction sheath 5 has a J-shaped elbow section 6, the inner channel 51 is the insertion channel of the prosthetic catheter 2 and the quadrupole elastic soft electrode 4, the prosthetic catheter 2 can be inserted into the J-shaped introduction sheath 1; it has a softer tube body The quadrupole elastic soft electrode 4 of 41 has a straight circular tube shape, which is soft as a whole, and has a distal end 23, a body portion 41 and a proximal end 3 ⁴ ; The distal end of the extremely flexible soft electrode 4 is the cathode 23, and a cable binding block 34 is attached at the proximal end. The cable binding block 34 is connected with a cable plug 33 that is connected to an external double-chamber temporary pacemaker. The steel wire 20 is inserted into the central cavity 24, and the J-shaped plastic wire is ready for use. The central cavity 24 has an insertion hole at the proximal end and no exit hole at the distal end.

The distal end 5 of the tubular J-shaped introduction sheath is blunt and smooth, and the long axis of the distal end of the J-shaped elbow of the J-shaped introduction sheath 1 is connected to the long axis of the J-shaped introduction sheath body, forming an arc angle of 120 °-160 °, Its purpose When the J-shaped elbow is introduced into the high right atrium through the right superior clavicle vein, it will not damage the blood vessels and myocardium. When the J-shaped elbow is twisted in vitro to point to the tricuspid valve, it can be inserted into its internal channel 51 The distal electrode 23 of the quadrupole flexible soft electrode 4 is directly introduced into the right ventricle for pacing.

 There is a V-shaped shank 7 at the proximal end 8 of the J-shaped introducer sheath 1 at both sides of the axial length of the body of the J-shaped introducer sheath 1 or some kind of weak structure so that the J-shaped introducer sheath 1 can be removed from The four-pole elastic soft electrode 4 is peeled off.

 The J-shaped introduction sheath 1 made of plastic is marked with a length mark 101 for reference during insertion, and the proximal end 8 of the J-shaped introduction sheath is marked with a direction mark 102 pointed by the J-shaped elbow. Accurately understand where the J-bend reaches and where the elbow is pointing.

 The proximal end of the J-shaped introducer sheath is equipped with a hemostatic valve 9 in the inner hole. The hemostatic valve is an elastic valve. The central hole allows the four-pole flexible soft electrode 4 and the prosthetic catheter 1 to pass. When it is removed, the central hole of the hemostatic valve 9 is closed. , It plays a role in stopping bleeding and preventing air from entering the blood circulation.

 The tubular body catheter 2 is a straight round tube, the distal end 12 is blunt and smooth, the tube body portion 11 is soft, and the proximal end 15 is provided with an inner hole 14 inserted into a syringe or a guide wire, and the center of the inner hole is a central cavity 13 Into the hole, the central cavity 13 can be guided by a guide wire from the proximal end to the distal end; the prosthesis catheter is suitable for fitting in the inner channel 51 of the J-shaped introduction sheath 1, and the distal end 12 of the prosthesis catheter 2 can be introduced into the distal end of the sheath 1 from the J-shape. The end 5 protrudes, the purpose of which is that the prosthetic catheter 1 can fill the space in the inner channel 51 of the J-shaped introduction sheath 1, and the distal end 12 of the prosthetic catheter 2 is blunt to prevent damage to the vessel wall and myocardium during insertion.

 The distal end 23 of the quadrupole flexible soft electrode 4 is the cathode 23, and the second pole 26 is adjacent to the cathode 23 for ventricular pacing; the third pole 27 and the fourth pole 28 are adjacent to the atrial pacing and are located far from the distal end. 23 distance is within the range of 10-20cm.

The four-pole elastic soft electrode 4 has the above-mentioned coaxial double-layered spiral coil structure, and there is an insulating layer 25 between the coaxial double-layered spiral coils. The inner coil layer 22 forms a central cavity 24, and is connected to the distal cathode. 23, the outer coil layer 32 is composed of three insulated guide wires 29, 30, 31, and the three insulated guide wires are respectively connected to the ^second pole ²⁶ , the ^third pole, and the fourth pole 28; the second pole 26, the third pole 27 and the fourth electrode 28 is a ring electrode, the insulating outer coil layer of wire wrapped around the insulating layer parallel to each other, isolated from each other, the first insulating section wire ²⁹ connected to the ^second electrode 26, ring electrode and the third electrode 27, Pass under 4 poles 28; the second insulated guide wire 30 is connected to the third pole 27 and pass under the ring electrode 4 pole 28; the ring electrodes 27 and 28 are insulated from the guide wire passing under them; the outer coil layer 32 is external The sheath 36 is covered, and the outer sheath protrudes to form a toothed fixed wing 35 near the distal cathode 23. The outer sheath layer 36 is made of a biocompatible material such as silicone rubber, polyurethane or other suitable plastic. Insulating layer 25 and toothed fixed wings 35; Four-pole flexible soft electrode has four tail cables 33, which are respectively connected to the inner coil layer and the distal cathode 23 and the outer coil layer 2nd, 3rd, 4th, and 4 cables Extends from the proximal cable collection block 34, and connects to the two-chamber temporary pacemaker. Wire end.

 The four-pole flexible soft electrode 4 body 41 is marked with a length mark 41 for accurate positioning and reference during insertion. The purpose is to accurately estimate the positions of the distal electrode 23, the third pole 27, and the fourth pole 28 during the insertion process.

 The distal end 23 of the quadrupole flexible soft electrode 4 has a toothed fixed wing 35, the purpose of which is to enable the distal end 23 of the electrode to be anchored in the myocardial trabeculae to prevent electrode displacement.

 The quadrupole flexible soft electrode 1 is provided with a straight shaped steel wire 20, which is slightly shorter than the axial length of the mated central cavity 24. The purpose is to enable the distal end of the quadrupole flexible soft electrode 1 to be inserted into the ventricle. Keep the soft end without damaging the myocardium.

 The four-pole flexible soft electrode 1 is equipped with J-shaped plastic wire 21, the distal end of the J-shaped plastic wire is a J-shaped elbow section, and the distal end of the J-shaped elbow is a soft end. The purpose is to make the J-shaped elbow easily inserted into the center Cavity 24, and does not damage the inner coil layer 22; a mildly curved curve section near the proximal end of the J-shaped elbow section is intended to adapt to the anatomically curved curve of the venous access, which is beneficial to the third electrode Pole and 4th pole abut the right atrium wall.

A method for using a rapid bedside temporary cardiac pacing device is characterized in that: The right internal jugular vein or right subclavian vein is punctured from the right supraclavicular route, and the guide wire is sent from the venous approach after puncturing. The venous approach is widened with a thick dilator, and then it is withdrawn. The characteristics are: The J-shaped guide sheath with the prosthetic catheter is inserted along the guide wire until the distal J-shaped elbow section of the J-shaped introducer sheath is introduced into the entrance of the high right superior atrial vena cava, and then the prosthetic catheter is removed together with the guide wire. And twist the J-shaped elbow section of the J-shaped introducer sheath into the tricuspid valve mouth of the patient in vitro, insert the quadrupole elastic soft electrode from the J-shaped introducer into the sheath channel until continuous right ventricular pacing occurs and it is determined that Until the stroke position is qualified, the straight shaped wire inserted in the central cavity of the quadrupole flexible soft electrode is pulled out, the electrode continues to be pushed forward to the set length, and the J-shaped wire is inserted into the center of the quadrupole flexible soft electrode. In the cavity, the third pole and the fourth pole of the quadrupole elastic soft electrode are brought into abutment with the right atrium side wall until the atrioventricular dual-chamber sensing and pacing appear and are qualified.

 As can be seen from the above, the advantages and effects of the present invention are as follows:

 The invention adopts a J-shaped introduction sheath to introduce an electrode catheter, which can quickly, simply, safely and reliably complete bedside emergency ventricular pacing at the bedside or the scene of the disease without X-ray guidance, which is very useful for the rescue of critically ill patients; The present invention adopts a quadrupole flexible soft electrode, which can prevent electrode displacement and prevent myocardial and vascular damage; meanwhile, a dual-chamber physiological temporary cardiac pacing can be quickly, simply, safely, and reliably realized at the bedside or at the scene of the disease. Salvage of critically ill patients and preventive cardiac pacing are very useful. The invention is suitable for popularization because of its simplicity and ease of learning.

 The technical solution is further explained below.

The present invention adopts a Γ-shaped introduction sheath with a J-shaped elbow section at its distal end. In this way, the J-shaped elbow is not made at the distal end of the catheter, but at the distal end of the J-shaped introducer sheath. Therefore, the electrode of the present invention does not need to be J-shaped at the distal end. When the J-shaped elbow of the J-shaped introduction sheath points to the tricuspid valve in vitro, the straight electrode leaves the J-shaped introduction sheath and the distal end will directly point to the three The cuspid valve is easily accessible to the apex of the right ventricle (see Figure 1). The venous approach selected by the present invention conforms to the shortest and straightest path from the tricuspid valve port and the right ventricular apex. Therefore, the standard-compliant approach is only the superior supraclavicular vein approach. Therefore, the J-shaped introduction sheath must have a certain hardness and Elastic and able to withstand blood temperature Keep the original shape, can twist outside the body and point to the front left 45 of the body. Pointing to the tricuspid valve. In order to cooperate with the use of this set of instruments, the puncture method we used is: The venous approach of the J-shaped introducer sheath is inserted by venipuncture and widened with a dilator. The supraclavicular vein puncture was performed using the Yof fa method to puncture the right subclavian vein or the Jernigan method to puncture the right internal jugular vein. The anatomical relationship of this approach is shown in Figures 1 and 2. The right internal jugular vein and the right subclavian vein merge into an innominate vein, and the intersection point forms a vein angle. The puncture point, the venous angle, the superior vena cava, and the right atrium wall form an arc that curves toward the right side of the body. The tricuspid valve and right ventricle are located just to the left anterior side of the entrance to the superior superior atrial vena cava. The long axis of the tricuspid valve and right ventricle is approximately 1 35 ° from the long axis of the superior vena cava. There are no important tissues and organs at the venous approach, the puncture needle reaches the vein only through the cervical fascial tissue. The puncture needle uses a fixed puncture direction, that is, 45 ° inward from the sagittal plane and 15 ° forward from the coronal plane. When the puncture needle is pushed forward, it is far away from the subclavian artery and cervical pleura. Hepatic nerve (Yof fa method). The Jernigan method is similar when puncturing the internal jugular vein. The internal jugular vein is just outside the internal carotid artery below the neck. The needle is inserted behind the sternocleidomastoid muscle bundle. The puncture needle must first enter the internal jugular vein. There is also only cervical fascia in the pathway. This is the basis for ensuring the safe operation of this law. By following this fixed puncture direction, subclavian artery injury, hemothorax, pneumothorax, and phrenic nerve injury can be avoided. According to our measurement results and experience, the insertion depth of the J-shaped introduction sheath should be 1/10 of the patient's length, and then the J-shaped elbow of the J-shaped introduction sheath is twisted outside the body to point to the tricuspid valve, which is the same as the sagittal plane. 45 ° angle, pointing to the front left of the body. At this time, this specially made straight pacing electrode can be inserted into the right ventricle through a J-shaped introducer sheath (Figure 1). The above assumptions have been fully realized in clinical validation. Special four-pole flexible soft electrode with fixed wings near the distal end. Its purpose is to improve the fixing performance of the electrode and prevent myocardial damage and perforation. When the straight shaped wire is inserted, the electrode becomes straight and helps The J-shaped sheath is inserted directly into the right ventricular apex. When the straight shaped wire is removed, the electrode becomes soft, which can prevent the electrode from damaging the myocardium. The quadrupole flexible soft electrode is designed to sense and pace the atrial and ventricular dual heart chambers in order to obtain dual-chamber physiological cardiac pacing without X-ray guidance at the bedside. After a straight shaped wire is inserted into its central cavity It can be inserted through a J-shaped sheath and directly into the right ventricle for pacing. When the distal end of the electrode is anchored in the muscle trabecula, after the J-shaped sheath and the straight shaped steel wire are removed, a J-shaped shaped wire can be used at the distal end. When inserted into its central cavity, the 3rd and 4th poles of the electrode can be pressed to the right atrium side wall, and the atrioventricular dual-chamber physiological cardiac pacing and sensing can occur immediately.

Brief description of the drawings

 FIG. 1 is a schematic diagram of an approach of inserting a J-shaped introduction sheath and an electrode according to the present invention; FIG.

 FIG. 2 is a schematic diagram of a single-electrode atrioventricular dual-chamber physiological cardiac pacing;

 3 is a plan view of a J-shaped introduction sheath of the present invention;

 4 is an enlarged perspective view of a J-shaped introduction sheath of the present invention;

 5 is a sectional view of a J-shaped introduction sheath structure of the present invention;

 6 is a cross-sectional view of a J-shaped introduction sheath of the present invention;

 7 is an external view of a prosthesis catheter of the present invention;

 8 is a cross-sectional view of the internal structure of the prosthesis catheter of the present invention;

 9 is a plan view of a J-shaped introducer according to the present invention; the J-shaped introducer is formed by assembling a J-shaped introducer sheath and a prosthetic catheter together;

 FIG. 10 is an external perspective view of a coarse dilator of the present invention;

 11 is an external view of a quadrupole flexible soft electrode according to the present invention;

 FIG. 12 is an internal structure diagram of a quadrupole elastic soft electrode according to the present invention; FIG.

 FIG. 13 is a cross-sectional view of the internal structure of a quadrupole flexible soft electrode according to the present invention;

 Fig. 14 is an external view of a J-shaped plastic wire according to the present invention.

Best practice

 The specific structure of the present invention will be described in detail below with reference to the accompanying drawings 1 to 14:

The curved money between arrows A and B in Figure 1, that is, the curve from the puncture point to the side wall of the right atrium, is an arc that spreads to the right side of the patient's body. This curve shows an approach in which the guide wire and the J-shaped introduction sheath 1 are inserted. The curve between arrow A and arrow C shows the J-shaped elbow 6 turns of the J-shaped introduction sheath 1 Direction and the way to insert the electrode. The J-shaped elbow 6 shaped into the sheath 1 is introduced into the upper cavity static entrance of the high right atrium, and then twisted to point to the right ventricle and the tricuspid valve. The long axis of the right ventricle and the tricuspid valve is 45 to the sagittal plane. Angle, with a cross section of 45. angle. Arrow D and dot indicate the puncture direction and puncture point of Jernigan's method. The curve between arrow D and arrow B is similar to the curve between arrow A and arrow B, which indicates that the guide wire is inserted when the internal jugular vein is punctured by Jernigan's method and: [the approach when introduced into sheath 1.

 Figure 2 shows that the electrode was inserted through the right supraclavicular approach, and the distal end of the electrode was anchored at the right ventricular apex. When the J-shaped wire was inserted, the third and fourth poles 27 and 28 of the electrode were pressed toward the high right atrium wall.

 Figures 3 to 6 are illustrations of the J-shaped introduction sheath, which can introduce the electrode from the outside into the right ventricular apex, and its distal end 5 has a: [formed by the long axis of the distal end of the elbow and the long axis of the J-shaped introduction sheath 120 °-160 ° J-shaped elbow section 6 with curved corners. The distal end 5 is round and blunt, and the side view is slightly oblique. The proximal end 8 has a V-shaped handle 7. In the central cavity of the proximal end 8, there is a sleeve-type hemostatic valve 9 for hemostasis and preventing air from entering. There are bilaterally symmetrical longitudinal grooves or bilaterally symmetrical vertical discontinuous incision lines 10 on the side wall of the J-shaped introduction sheath body and the side wall of the V-shaped handle 7 for the completion of the pacing process. The J-shaped introducer sheath was then peeled from the electrode. The J-shaped introduction sheath has an inner diameter of 6 to 8Fr and an outer diameter of 8 to 12Fr. It is 5cm from the distal end and is marked with a length mark 101. Proximal end 8 should be marked with a J-bend pointing 102. The J-shaped introducer sheath should be stiff and flexible, and made of polyethylene or other plastic suitable for the body.

FIG. 7 and FIG. 8 are diagrams of the prosthetic catheter 2. The prosthetic catheter 2 is suitable for being filled in the channel 51 inside the J-shaped introduction sheath 1 to fill the space. It has a softer body 11, a blunt and rounded distal end I ^{2 that} when inserted into the J-shaped introducer sheath, it protrudes from the distal end 5 of the helical introducer sheath 3 to 5 cm. The prosthesis catheter has a central lumen 13 for inserting a guide wire, and a proximal end 15 having an inner port 14 for connecting a syringe or introducing a guide wire. The prosthetic catheter is adapted to be inserted into a J-shaped intrathecal channel 51. Its blunt and rounded distal end 12 and softer body 11 are negligent when inserted, and the guide wire is not fully fed into a sufficient length to prevent damage to the vessel wall and heart. Figure 10 is a schematic diagram of a coarse dilator. It is used to widen the venous approach of the J-shaped introducer sheath 1, and its outer diameter is slightly larger than the outer diameter of the J-shaped introducer sheath 1. The proximal end 17 has a handle 16 attached to the syringe, the central lumen 18 can be fed with a guide wire, and the distal end 19 is tapered and tapered for widening the access to the vein.

 Figures 11 to 13 are diagrams of the four-pole elastic soft electrode 4, which is provided with a straight shaped steel wire 20 inserted in its central cavity 24, and a JT shaped shaped steel wire 21 is ready for use. It has a coaxial double coil structure. It has an inner spring coil layer 22 whose wires are connected to the distal cathode 23. The coil 22 surrounds the central cavity 24 and can be inserted into the shaped wire 20. The inner coil layer 22 is covered by an insulating layer 25 made of silicone rubber, polyurethane, or other body-friendly plastic. The second pole 26, the third pole 27, and the fourth pole 28 are ring electrodes, which are respectively connected to the guide wires 29, 30, and 31 of the outer insulation layer. The insulating guide wires 29, 30, 31 are wound in parallel and isolated from each other around the insulating layer 25 to form an outer coil layer 32. The guide wire 29 is connected to the second pole 26 and passes under the third pole 27 and the fourth pole 28. The guide wire 30 is connected to the third pole 27 and passes under the fourth pole 28. The ring electrode is connected to the guide wires 29 and 30 passing below. insulation. The distal cathode 23 is close to the second pole 26; the third pole 27 and the fourth pole 28 are close to each other and within a range of 10 to 20 cm from the far end. Four tail cables 33 are branched from the cable connection block 34 and are connected to the four connectors of the external double-chamber temporary pacemaker. The outer sheath protrudes near the distal cathode 23 to form a small toothed fixed wing 35. The electrode is provided with a length mark at a fixed position away from the distal end 23 to facilitate the insertion of the electrode. The J-shaped plastic wire 2 1 is a J-shaped elbow at the distal end and a soft end 211 at the distal end of the J-shaped elbow to facilitate insertion into the central cavity. Inside, near the J-shaped elbow section is an arc-shaped lightly curved section consistent with the direction of the J-shaped elbow.

The specific operation method and implementation process of the present invention are as follows: the patient is to lie flat, without a pillow or placing a small pillow between 7 and 8 cm in height between the scapula. When the jugular vein pressure of the patient is low, the head is lowered and the foot is high. Identify its location. When this part is not clear, put your hand on the patient's forehead and ask her to resist neck flexion, which can expose the sternocleidomastoid muscle angle. The area is clean and draped. When the patient is lying supine, the center of the sag at 1 cm below the angle of the sternocleidomastoid muscle is the puncture point, where a local anesthesia is made, and a small skin incision is made with a Noll blade to cut through the skin and subcutaneous tissue. Press firmly with a puncture needle with a syringe Orientation puncture, that is, 45 ° inward from the sagittal plane and 15 ° forward from the coronal plane (Yof fa's transclavicular subclavian vein puncture method). When the dark red blood was sucked into the syringe, the syringe syringe was removed, and a drop of blood dripped out, indicating that the puncture needle has entered the subclavian vein, and the average penetration depth of the puncture needle is about 2 to 4 cm. The J-end of the guide wire is fed into about 30 cm through the puncture needle, and the wire is pulled back and forth. If there is no resistance, it indicates that it has entered the central venous system. The thick dilator is inserted along the guide wire to widen the venous approach. The coarse dilator is removed, the J-shaped sheath is inserted into the prosthetic catheter, and the guide wire is inserted along the guide. The distal elbow of the J-shaped introducer sheath should continue to point to the right side of the body until: The T-elbow reaches the entrance of the high right superior atrial vena cava. Insert the J-shaped sheath into the patient's length 1

/ ιο. The prosthetic catheter is then removed along with the guide wire. J-shaped introduction sheath: The r-shaped elbow is twisted outside the body and points to the front left 45 of the patient's body. Pointing to the tricuspid valve. The external dual-chamber pacemaker has been preset in the VV1 (or DDD) pacing state: that is, the ventricular stimulation amplitude is 3V, the pacing heart rate is greater than the patient's own ventricular rate, 20 bpm, and the sensitivity is 3 to 5 mv. The quadrupole flexible soft electrode cable has been connected to the dual-chamber pacemaker and inserted from the J-shaped lead into the sheath until the continuous right ventricular cardiac pacing wave group appears on the ECG monitor screen. At this time, it is clearly sensed when the electrode is in contact with the ventricular membrane. "Collision". Then the straight shaped wire retracts 10 to 15 cm, and you should feel the anchoring feeling at the distal end of the electrode. Push the electrode 3 to 5 cm forward. Observe whether the pacing signal can be captured when the patient inhales deeply, coughs or changes position. Ventricle, and observe pacing threshold and perceived sensitivity. At this time, the electrode insertion depth should generally be within the range of 1/10 + 10-15 cm of the patient's length. If the insertion length is less than this length, there should be a clear anchoring feeling. If the pacing parameters are determined to be acceptable, the pacing site can be accepted. . After that, a 25-30 cm metal or plastic ruler is placed under the electrode and the J-shaped introducer sheath as a support to keep the electrode from moving in the body, and then the J-shaped introducer sheath is removed from the body. The right ventricular pacing steps are summarized as follows:

 1.Use the Yof fa method to puncture the right subclavian vein or the Jernigan's method to puncture the right internal jugular vein;

2. Feed the guide wire and widen the venous approach; 3. The J-shaped elbow of the J-shaped introduction sheath is introduced into the high right superior atrial vena cava population;

 4. The J-shaped elbow of the J-shaped introduction sheath points to the tricuspid orifice in vitro;

 5. Insert the quadrupole elastic electrode from the J-shaped lead into the sheath until continuous right ventricular pacing occurs and the pacing position is determined to be qualified;

 Unplug the straight shaped wire and push the electrode forward to the set length, that is, the patient's length is 1/10 plus the distance from the distal end of the electrode to the 4th pole. Adjust the pacing mode to DDD and adjust the pacing parameters. For example, the AV delay is 150 ms, the atrial sensory sensitivity is 0.1-0.5 mv, and the atrial stimulation amplitude is 3 V. Insert the J-shaped wire into the center cavity of the electrode, and move it up and down gently to make the 3rd and 4th poles abut the right atrium side wall, and then the two-chamber sensing and pacing of the atrium can occur. Atrioventricular double-chamber pacing steps are summarized as follows (continued from Article 5)

 6. The straight shaped wire is pulled out, and the electrode continues to be pushed forward to the set depth;

 7. Insert the J-shaped plastic wire, and place the 3rd and 4th poles against the side wall of the right atrium until the atrioventricular double-chamber sensing and pacing appear.

 8. Reset the pacing mode and parameters according to the actual situation of the patient.

Claims

Rights request 1. A rapid bedside temporary cardiac pacing device, which has a J-shaped introduction sheath (1), a prosthetic catheter (2) inserted into its inner channel (51), and a quadrupole flexible soft electrode (4). Lies in:  (a) The J-shaped introduction sheath (1) has a circular tube shape, and has a distal end (5), a body part (10), and a proximal end (8). The proximal end (8) is provided with a hemostatic valve (9) in the inner hole. The part (10) has a straight tube shape, the distal end (5) has a J-shaped elbow section (6), the inner channel (51) is the insertion channel of the prosthetic catheter (2) and the quadrupole flexible soft electrode (4), and the prosthesis The catheter (2) can be inserted into the J-shaped introduction sheath (1);  (b) the quadrupole flexible soft electrode (4) has a straight circular tube shape, is soft as a whole, and has a distal end (23), a body (41) and a proximal end (34); the distal end (23) is a cathode and the proximal end ( 34) Attached with a cable combination block (34), the cable combination block (34) leads out 4 cable plugs (33) that are connected to the external double-chamber temporary pacemaker, and the electrode is provided with a drawing plastic in the axial length. Central cavity (24), the straight shaped steel wire (20) is inserted into the central cavity (24), the J shaped plastic wire (21) is ready for use, and the central cavity (24) has an insertion hole (24) at the proximal end ), The distal end (23) has no holes.  2. A rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the distal end (5) of the J-shaped introduction sheath (1) is blunt and smooth, and the J-shaped introduction sheath (1) The J-shaped elbow section (6) is 120 ° ~ 160. An arc-shaped bend formed by the long axis of the distal end of the J-shaped elbow and the long axis of the sheath. 3. A rapid bedside temporary cardiac pacing device according to claim 1 or 2, characterized in that: a V-shaped handle (7) is provided at the proximal end (8) of the J-shaped introduction sheath, and the J-shaped introduction sheath is (1) Both sides of the axial length of the pipe body and the two sides connected to the V-shaped handle (7) of the body are provided with discontinuous incision lines or longitudinal grooves (10) or weak lines for tearing.  4. A rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the prosthesis catheter (2) inserted into the inner channel (51) of the J-shaped introduction sheath (1) is straight. The tube is round, the distal end (12) is blunt and smooth, and the body (11) is soft. The proximal end (15) is provided with an inner hole (14) for connecting a syringe or a guide wire, and the central cavity (13) can be inserted With the guide wire, after the prosthetic catheter (2) is fitted in the J-shaped introduction sheath channel (51), the distal end (12) of the prosthetic catheter protrudes from: [the distal end of the shaped introduction sheath (5).  5. A rapid bedside temporary cardiac pacing device according to claim 1 or 2, characterized in that: the body section of the J-shaped introduction sheath (1) is marked with a length mark (101 for reference when inserting) ), At the proximal end (7) of the J-shaped introduction sheath, mark the direction mark (102) pointed by the J-shaped elbow. 6. A rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the four-pole elastic soft electrode (4) has a coaxial double-layer spiral coil structure, There is an insulating layer (25) in between, the inner coil layer (22) forms the central cavity (24), and is connected to the distal cathode (23), and the outer coil layer (32) is composed of three insulating guide wires (29) coated with insulating material ), (30), (31), and 3 insulated guide wires are connected to the 2nd pole (26), the 3rd pole (27), and the 4th pole (28) respectively; the 2nd pole, the 3rd pole, and the 4th pole The poles are ring electrodes, and the insulating guide wires of the outer coil layer (32) are wound around the insulation layer in parallel with each other and isolated from each other; the first insulating guide wire (29) is connected to the second pole (26), and the ring electrode is at the third pole (27) and the fourth pole (28) pass through; the first insulation guide wire (30) is connected to the ^third pole ( ²⁷ ), and passes under the ring electrode fourth pole (28); the third insulation guide wire is connected The fourth pole (28), the ring electrodes (27), (28) and the guide wire ( ² 9) (30) passing below are insulated from each other; The wire coil layer (32) is covered by an outer sheath (36); the outer sheath covering the inner coil layer (22) protrudes to form a toothed fixed wing (35) near the distal cathode (23), and is used to anchor the distal end of the electrode , Made of biocompatible material silicon rubber, polyurethane or other body-friendly plastic, made of outer sheath, coaxial double-layer spiral coil insulation and toothed fixed wings; four-pole flexible soft electrode with four tail cables (33 ), Connect the inner coil layer (22) far pole cathode (23) and outer coil layer 2 (26), 3 (27) and 4 (28) respectively; four tail cables from the proximal cable combination block (34) Divided, respectively connected to the corresponding terminals of the dual-chamber temporary pacemaker. 7. A rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the quadrupole flexible soft electrode (4), the second pole (26) is adjacent to the distal cathode (23), the first The 3 pole (27) is adjacent to the 4 pole (28) and is located within a range of 10 to 20 cm from the distal end. The quadrupole flexible soft electrode body (41) is marked with a reference length mark (41) for accurate positioning during insertion. ) ₀ 8. A rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the four-pole elastic soft electrode (4) is provided with two shaped steel wires, and the straight shaped steel wire (20) is straight. Filament-shaped, shorter than the axial total length of the central cavity (24) into which the shaped steel wire is inserted; the J-shaped shaped steel wire (21) has a J-shaped elbow at the distal end, and the soft end (211) ), There is a slightly curved curved section near the proximal end of the J-shaped elbow section. 9. A method for using a rapid bedside temporary cardiac pacing device according to claim 1, characterized in that: the right internal jugular vein or the right subclavian vein is punctured from the right supraclavicular route, and the guide wire is guided from the punctured Intravenous approach, use a wide dilator to widen the venous approach, then withdraw it, and insert the prosthesis catheter (2): r-shaped introduction sheath (1) into the guide wire until the J-shaped introduction sheath The distal end (1) (5) of the J-shaped elbow (6) is introduced into the entrance of the high right superior atrial vena cava, and then the prosthetic catheter (2) is removed along with the guide wire and placed in the body The J-shaped elbow section (6) of the J-shaped introduction sheath (1) is twisted toward the tricuspid valve mouth of the patient, and the quadrupole flexible soft electrode (4) and the external double-lumen temporary heart with adjusted pacing parameters are started. Connect the pacemaker, then insert the quadrupole flexible soft electrode (4) from the J-shape into the inner channel (51) of the sheath (1) until continuous right ventricular pacing occurs and it is determined that the pacing position is qualified, and then the J-shape The introduction sheath (1) is withdrawn from the body, and the straight shaped steel wire (20) inserted in the central cavity (24) of the quadrupole flexible soft electrode (4) is pulled out, and the electrode continues to be pushed forward to a set length, Then insert the J-shaped plastic wire (21) into the central cavity (24) of the four-pole flexible soft electrode (4), so that the third pole (27) and the fourth pole (28) of the four-pole flexible soft electrode (4) are pasted. Lean on the right atrium wall until atrioventricular dual-chamber sensing and pacing appears and is deemed eligible.