目的 探索超声两点预定位辅助腋静脉穿刺在心脏起搏器植入中的有效性和安全性。 方法 纳入2022年5月至2023年12月需要植入心脏起搏器的患者63例，随机分为常规手术组（n = 31）和超声两点预定位组（n = 32）。常规手术组按照手术常规准备。超声两点预定位组术前应用超声进行腋静脉检查，进行两点预定位，一点为皮肤进针点，另一点指示进针方向，同时超声探头与皮肤呈30°测量穿刺深度，从而确定穿刺点、穿刺方向及穿刺深度，术中不用超声，依据术前定位进行穿刺。比较两组首针穿刺成功率、穿刺时间、穿刺次数、X线曝光时间和剂量、手术时间、起搏阈值、感知、阻抗等参数的差异评估有效性，比较气胸、血胸、动脉损伤、囊袋血肿、感染、电极脱位、磨损情况评估安全性。 结果 两组患者间的基线临床特征、CIED植入适应证和类型差异无统计学意义（P > 0.05）。与常规手术组相比，超声两点预定位组具有更高的首次穿刺成功率（38.2% vs. 63.2%，P = 0.008），更短的穿刺时间［36.0（17.5，79.0）s vs. 20.0（9.0，34.0）s，P = 0.004］，更少的穿刺次数［2（1，4）次 vs. 1（1，3）次，P = 0.005］，更少的X线曝光时间和剂量［12.4（7.1，20.3）min vs. 6.2（5.5，9.4）min，P = 0.003；60.0（24.7，168.1）mGy vs. 29.0（16.6，46.4）mGy，P = 0.010］，但总手术时间差异无统计学意义［（149.19 ± 41.81）min vs. （131.90 ± 40.05）min，P = 0.099］。两组间起搏器参数和不良事件发生率差异无统计学意义（P > 0.05）。 结论 在心脏起搏器植入术中，超声两点预定位辅助腋静脉穿刺是一种安全、有效、实用的方法。

Objective To explore the efficacy and safety of ultrasound-guided two-point pre-localization-assisted axillary vein puncture in cardiac pacemaker implantation. Methods Sixty-three patients who needed cardiac pacemaker implantation between May 2022 and December 2023 were included in the study and randomly allocated into a conventional surgery group （n = 31） and an ultrasound two-point pre-localization group （n = 32）. The conventional surgery group underwent preparation following routine surgical procedures. In the ultrasound two-point pre-localization group， preoperative ultrasound was employed to conduct a two-point localization of the axillary vein. One point was designated as the skin puncture site， and the other indicated the puncture direction. Additionally， the ultrasound probe was positioned at an angle of 30° to the skin to measure the puncture depth， thus determining the puncture site， direction， and depth. During the surgery， ultrasound was not utilized， and the puncture was carried out based on the preoperative localization. The differences in parameters such as the first-attempt puncture success rate， puncture time， number of punctures， X-ray exposure time and dose， surgical time， pacing threshold， sensitivity， and impedance were compared to evaluate the efficacy. Safety was evaluated by comparing the incidence of pneumothorax， hemothorax， arterial injury， pocket hematoma， infection， electrode dislodgement， and wear. Results There were no statistically significant differences in baseline clinical characteristics， CIED implantation indications， and device types between the two groups （P > 0.05）. When compared with the conventional surgery group， the ultrasound two-point pre-localization group exhibited a higher first-attempt puncture success rate （38.2% vs. 63.2%， P = 0.008）， a shorter puncture time ［36.0（17.5， 79.0） s vs. 20.0（9.0， 34.0） s， P = 0.004］， fewer puncture attempts ［2（1， 4） vs. 1（1， 3）， P = 0.005］， less X-ray exposure time and dose ［12.4（7.1， 20.3） min vs. 6.2（5.5， 9.4） min， P = 0.003； 60.0（24.7， 168.1） mGy vs. 29.0（16.6， 46.4） mGy， P = 0.010］. However， there was no significant difference in the total surgical time ［（149.19 ± 41.81） min vs. （131.90 ± 40.05） min， P = 0.099］. Additionally， there were no statistically significant differences in pacemaker parameters and adverse event rates between the two groups（P > 0.05） Conclusion Ultrasound-guided two-point pre-localization assisted axillary vein puncture is a safe， effective， and highly practical method in cardiac pacemaker implantation.