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|本期目录/Table of Contents|

右室流出道间隔部起搏的血流动力学观测(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第6期
页码:
773-775
栏目:
临床研究
出版日期:
2008-12-25

文章信息/Info

Title:
Effects of pacing on hemodynamics in right ventricular outflow tract
作者:
刘庆军1; 钱剑峰1; 刘峰1; 茹铁周1; 潘文1; 毛家亮2
1.昆山市中医院心内科，江苏 昆山 215300； 2.上海交通大学附属仁济医院心内科，上海 200001
Author(s):
LIU Qingjun1;  QIAN Jianfeng1;  LIU Feng1;  RU Teizhou1;  PAN Wen1;  MAO Jialiang2
1.Deptment of Cardiology, Kunshan Traditional Chinese Medcine Hospital, Kunshan 215300, Jiangsu, China; 2.Deptment of Cardiology, Affiliated Renji Hospital, Shanghai Jiaotong University, Shanghai 20001, China
关键词:
心脏起搏; 心室间隔部; 右室心尖部; 血流动力学; 多普勒超声心动描记术
Keywords:
cardiac pacing;  right ventricular septum;  right ventricular apex;  hemodynamics;  echocardiography
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的 比较右室流出道间隔部（RVS）与右室心尖部（RVA）起搏对血流动力学的影响。方法 选择具备起搏器植入指征的患者30例，随机分为RVA组与RVS组，采用超声心动图检测左室射血分数（LVEF）、每搏量（SV）、左室短轴缩短率（FS）、心脏指数（CI）,对比观察术前、术后3，6个月差异。并比较术前与术后心电图QRS波宽度。结果 两组患者均顺利完成手术。两组QRS波时限均较自身心律时延长，差异有统计学意义（P<0.01），RVA组起搏QRS时限显著长于RVS组［（158±15）ms vs (132±15)ms,P<0.01］；RVA组术后3个月随访LVEF，SV，FS，CI较术前均显著降低，均有统计学意义［（59±3）% vs (51±3)%,(79±15)ml vs (71±16)ml,(0.36±0.11) vs (0.31±0.09),(2.5±0.4)L/(min·m2) vs (2.1±0.4)L/(min·m2),均P<0.05］；RVS组术后3，6个月随访LVEF，SV，FS，CI与术前无显著性差异，RVS组3，6个月随访LVEF，SV，FS，CI均显著高于同期RVA组，均有统计学意义（均P<0.05）。结论 RVS起搏尽可能的保证了心室激动和收缩同步性，实现了比RVA起搏 较为良好的血流动力学状态。
Abstract:
AIM To compare the effects of pacing on hemodynamics in right ventricular septum and in right ventricular apex. METHODS Thirty patients performed with DDD or VVI pacing were grouped randomly into two groups, 15 patients in one group received RVS pacing, while 15 patients in the other group received RVA pacing. The QRS waves of the ECG of the preoperation and the postoperation were recorded and analyzed. The hemodynamic parameters of LVEF, SV, FS and CI were compared between preoperation, 3 months and 6 months after operation by echocardiography. RESULTS The QRS duration in RVA group was longer than that in RVS group significantly ［（158±15） vs (132±15)ms, P<0.01］. Compared with RVA pacing, RVS pacing better improved LVEF, SV, FS and CI ［(58±4) vs (51±3)%, (77±15) vs (71±16)ml, (0.37±0.10) vs (0.31±0.09), (2.5±0.4) vs (2.1±0.4)L/(min·m2), P<0.05］ three months after implantment of pacemakers. The LVEF, SV, FS and CI of RVA group 3 months after operation decreased significantly ［（59±3）% vs (51±3)%, (79±15)ml vs (71±16)ml, (0.36±0.11) vs (0.31±0.09), (2.5±0.4) L/(min·m2) vs (2.1±0.4)L/(min·m2), P<0.05)］. CONCLUSION Compared with RVA pacing, RVS pacing presents a more physiological depolarization pattern and better hemodynamics.

参考文献/References

［1］ de Cock CC, Giudici MC, Twisk JW. Comparison of the haemodynamic effects of right ventricular outflowtract pacing with right ventricular apex pacing: A quantitative review［J］. Europace, 2003, 5(3):275-278.

［2］ Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker thearpy for sinus node dysfunction［J］. Circulation, 2003, 107(23):2932-2937.

［3］ 郭诗东,华伟,张澍,等. 右室间隔部起搏的血流动力学研究［J］. 中国介入心脏病学杂志, 2005, 13(2)：81-83.

［4］ Takagi Y, Dumpis Y, Usui A, et al. Effects of proximal ventricular septal pacing on hemodynamic and ventricular activation［J］. Pacing Clin Electrophysiol, 1999, 22(12):1777-1781.

［5］ 蔡林,黄德嘉,燕纯伯,等. 心脏选择性部位起搏的电和机械同步性研究的初步报告［J］. 中华心血管病杂志, 2007, 35(2):147-150.

［6］ 王蔚,孟素英,陈哲明,等. 组织多普勒成像评价右心室心尖部与右室流出道起搏对心功能的影响［J］. 心脏杂志, 2007, 19(2):226-229.

备注/Memo

备注/Memo:
收稿日期：2007-11-05.作者简介：刘庆军，副主任医师，硕士Email:LqJ@kstcm.org.cn
更新日期/Last Update: 2009-03-24