右心室间隔部起搏的血流动力学研究  

Hemodynamics research in patients with right ventricular septal pacing

作　　者：郭诗东 华伟[1] 张澍[1] 王方正[1] 陈柯萍[1] 吴国玫 陈新[1] 

机构地区：[1]中国医学科学院阜外心血管病医院临床电生理研究室,北京中日友好医院急诊科100037

出　　处：《中国介入心脏病学杂志》2005年第2期81-83,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　比较右心室间隔部与右心室心尖部起搏对血流动力学的影响。方法　慢性心房颤动伴长RR间歇或缓慢心室率需植入永久起搏器患者1 0例,均采用抑制型按需心室起搏模式(VVI)。通过超声心动图检查,自身对照研究右室间隔部与右室心尖部起搏的血流动力学差异。结果　术中1 0例患者利用螺旋电极均成功进行了右室间隔部固定,未发生并发症。与术前相比,术中右室心尖部(RVA)起搏时左室射血分数(LVEF)和每搏量(SV)均显著降低( 0 . 56±0. 1 4vs 0 . 6 2±0 .1 4 ,6 7 .72±2 2 . 35mLvs 80 .94±2 2 . 0 4mL ,P <0 . 0 5) ;与术前相比,术中右室间隔部(RVS)起搏时LVEF和SV未显示显著差异;术中RVS起搏的血流动力学参数明显优于RVA起搏(LVEF 0 6 0±0 . 1 3vs 0 . 56±0 . 1 4 ,P <0 .0 5;SV 76 . 97±1 7. 2 3mLvs 6 7 .72±2 2 . 35mL ,P <0. 0 5)。结论　与术前相比,RVA起搏恶化血流动力学,RVS起搏对血流动力学无明显不良影响。RVS起搏通过最大限度地保持正常心室激动顺序和双心室收缩的同步性,实现较为良好的血流动力学状态。Objective To compare the hemodynamic changes of right ventricular septal pacing with traditional right ventricular apical pacing. Methods Ten patients with chronic atrial fibrillation and long RR interval or slow ventricular beats received permanent VVI pacing. In each patient, the influence of pacing site to hemodynamic was examined by ultrasonic cardiogram (UCG). Results The screw-in pacing leads were implanted successfully at RVS in all patients without any complication. As compared with baseline, the hemodynamic parameters during right ventricular pacing were decreased significantly (LVEF 0.56±0.14 vs 0.62±0.14, P <0.05; SV 67.72±22.35 mL vs 80.94±22.04 mL, P <0.05). There were no significant changes during right ventricular septal pacing. The hemodynamic parameters during RVS pacing were significantly better than that during RVA pacing(LVEF 0.60±0.13 vs 0.56±0.14, P <0.05; SV 76.97±17.23 mL vs 67.72±22.35 mL, P <0.05). Conclusion The hemodynamic parameters during RVA pacing were significantly worse than that at baseline condition and there were no significant difference between RVS pacing and intrinsic rhythm, The hemodynamic parameters of right ventricular septal pacing were significantly better than that of right ventricular apical pacing. The mechanism of hemodynamic effect of RVS pacing maybe related to keeping normal ventricular activation sequence and biventricular contraction synchrony.

关 键 词：右心室间隔部起搏 血流动力学研究 右心室心尖部起搏 植入永久起搏器 超声心动图检查 右室心尖部起搏 血流动力学参数 血流动力学状态 慢性心房颤动 自身对照研究 左室射血分数 心室激动顺序 缓慢心室率 起搏模式 螺旋电极 

分 类 号：R541.75[医药卫生—心血管疾病] R774.13[医药卫生—内科学]