我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

Ⅲ度房室传导阻滞患者安置双腔起搏器初期起搏模式的选择(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2006年第1期
页码:
83-86
栏目:
临床研究
出版日期:
2006-01-01

文章信息/Info

Title:
Initial modal option of dualchamber pacing in patients with Ⅲ°AVB
作者:
寿锡凌; 吉海鸣; 崔翰斌; 陈新义; 梁磊; 官功昌; 樊应书
陕西省人民医院心内科，陕西 西安710068
Author(s):
SHOU Xi-ling;  JI Hai-ming;  CUI Han-bin;  CHEN Xin-yi;  LIANG Lei;  GUAN Gong-chang;  FAN Ying-shu
Department of Cardiology, Shaanxi Provincial People′s Hospital, Xi′an,Shaanxi 710068, China
关键词:
Ⅲ度房室传导阻滞;  心脏扩大;  双腔起搏;  血流动力学;  模式选择
Keywords:
Heart enlargement; Dualchamber pacing;  Hemodynamic; Modal option
分类号:
R541.76
DOI:
-
文献标识码:
A
摘要:
目的 探讨不同频率起搏对心脏扩大、心电图有明显心肌缺血患者心功能的影响，从而进一步探讨Ⅲ度房室传导阻滞(Ⅲ度AVB)安置双腔起搏器初期起搏模式的选择。方法 心脏扩大、心电图有明显心肌缺血的Ⅲ度AVB患者（心脏扩大组）20例,心脏不大，心电图无心肌供血不足的病窦综合征(SSS)、Ⅲ度AVB患者（对照组）10例,置入DDD起搏器。经右头静脉和（或）右锁骨下静脉插入双腔起搏电极导线，经左侧锁骨下静脉插入SwanGanz导管，测量不同起搏频率时血流动力学效应。结果 在急性起搏时，心脏扩大组当双腔起搏频率在60～80次∕min时，血流动力学指标较起搏前有显著改善，当双腔起搏频率≥110次∕min时，血流动力学指标较起搏前显著变差；而对照组起搏频率在70次∕min以上时，血流动力学指标与起搏前相比均显著改善；心脏扩大组中窦房结变时功能正常者，双腔起搏频率提高到110次∕min或以VAT方式工作，心室率（VR）≥110次∕min，血流动力学指标显著差于起搏前及VVI起搏（频率60次∕min），VVI起搏（频率60次∕min）时血流动力学指标优于起搏前。结论 有心肌供血不足伴心脏扩大的严重缓慢VR的Ⅲ度AVB患者，在起搏器安置初期，将起搏上限跟踪频率下调到90～100次∕min，或程控为VVI工作方式为宜。
Abstract:
AIM To investigate the effect of pacing frequency on cardiac functions in patients with enlarged hearts and ischemia and to choose a modal option of dualchamber pacing at initial stage in patients with Ⅲ°AVB. METHODS The DDD pacemakers were implanted in 20 Ⅲ°AVB patients with heart enlargement and ECG documented ischemia (heart enlargement group) and in 10Ⅲ°AVB or SSS patients with normal heart size and no ischemia (control group). The pacing electrode lead was introduced along the right cephalic vein and/or subclavian vein. Acute hemodynamic effect of different pacing frequency was evaluated by SwanGanz catheter introduced from the left subclavian vein to pulmonary artery. RESULTS In heart enlargement group, hemodynamic effects were significantly improved when DDD pacing frequency was set at 60 to 80 bpm, whereas they were worse at more than 110 bpm. In control group hemodynamic effects were significantly improved when DDD pacing frequency was set over 70 bpm. In patients with enlarged hearts, normal sinus chronotropic and Ⅲ°AVB, acute hemodynamic effects were worse when DDD pacing frequency was set at 110 bpm or at VAT mode with ventricular rate (VR) over 110 bpm, compared with those before pacing or VVI pacing at 60 bpm. While acute hemodynamic effects of VVI pacing at 60 bpm were better than those before pacing in heart enlargement group. CONCLUSION It is beneficial for patients with Ⅲ°AVB of severe bradycardia arrhythmias, heart enlargement and ischemia, that upper limit of trail pacing frequency should be decreased to 90～100 bpm, or pacing mode be programmed to VVI.

参考文献/References

［1］ 寿锡凌，陈新义，官功昌，等. 与生理性起搏有关的急性左室心力衰竭2例［J］. 心脏杂志， 2001，13：160.

［2］ Dipla K, Mattiello JA, Jeevanandam V,et al. Myocyte recovery after mechanical circulatory support in humans with endstage heart failure［J］. Circulation, 1998,97:2316-2322.

［3］ 卢才义，郄晓红，黄从新，等. 置入起搏器围手术期并发症的处理三例［J］. 中国心脏起搏与电生理杂志, 1997，11：14.

［4］ Bakker PF, Meijburg H,De Torge N, et al. Beneficial effects of biventricular pacing in congestive heart failure(abstr)［J］. PACE, 1994,17:820-828.

［5］ 张必胜，林贵轩，张桐玉. VDD起搏对缓慢性心律失常心力衰竭的血流动力学影响［J］. 中国心脏起搏与电生理杂志, 1998，12（3）：147-149.

备注/Memo

备注/Memo:
收稿日期：2005-07-18.基金项目：陕西省社发攻关基金项目资助（No.2004K14-G5）作者简介：寿锡凌，主任医师，硕士 Tel：(029)852513312381 Email： shouxiling@163.com
更新日期/Last Update: