关键词: 穿刺术, 腋静脉, 锁骨下静脉, 心血管病学, 心内膜电极, 定位

Abstract: Objective To evaluate the clinical value of a novel method of axillary vein puncture using sole anatomical landmark. Methods A total of 96 consecutive patients referred for pacemaker implantation were enrolled and randomly divided into axillary vein puncture group (n=48) and subclavian vein puncture group (n=48). The junction point of medial and middle third of the clavicle was located as the sole landmark in axillary vein puncture group. Deflected lateral 45° from sagittal line, an 18-guage needle’s tip was laid on the point, and the hub was identified as puncture entry point. The needle was directed to the landmark at approximately 30°~45° relative to the body’s surface. The standard methods of subclavian vein puncture were applied in the other group. The vein puncture time, adjustment puncture ratio under X-ray, success rates of blind puncture and total puncture and complications associated with puncture were compared between the two groups. Results Compared with subclavian vein puncture group, there were longer puncture time (min: 3.35±0.97 vs. 2.74±0.90， P＜0.01) and more ratio of adjustive puncture under X-ray (22.91% vs. 8.33%, P＜0.05) in axillary vein puncture group. There were no significant differences in success rates of blind puncture (70.83% vs. 81.25%) and total puncture (93.75% vs. 89.58%) between the two groups (P＞0.05). No vascular complications were found in axillary vein puncture group, and four cases of complications associated with puncture were observed in subclavian vein puncture group. Conclusion The method of axillary vein puncture using sole anatomical landmark has high success rate, less complications and high clinical applicability.

Key words: punctures, axillary vein, subclavian vein, cardiovascular disease, endocardial electrode, localization