右心室流出道起搏与右心室心尖部起搏的血流动力学对比  

Contrast study of hemodynamics between RVOT pacing and RVA pacing

作　　者：曹源[1] 吴贻全[1] 洪明[2] 吴书林[3] 

机构地区：[1]深圳市第五人民医院心内科,广东深圳518001 [2]江西省心血管病研究所,南昌330006 [3]广东省心血管病研究所,广州510100

出　　处：《岭南心血管病杂志》2005年第3期192-194,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的比较右心室流出道与右心室心尖部起搏的血流动力学效果,并评价螺旋电极右心室流出道起搏的可行性。方法52例拟用螺旋电极进行人工心脏起搏的患者,先后将电极分别放在右心室心尖部和右心室流出道起搏,同时用温度稀释法及右心导管术测血流动力学指标:并测定患者不同部位的起搏参数和心电参数。结果右心室流出道起搏血流动力学指标改善优于右心室心尖部起搏,右心室流出道起搏时,心排血量、心脏指数、肱动脉收缩压、平均肺动脉压和肺毛细血管楔压分别为(7.0±1.4)L/min,(4.1±0.8)L·min-1·m-2,(130±21)mmHg,(14±3)mmHg,(8±3)mmHg;而在右心室心尖部起搏时分别为(6.2±1.2)L/min,(3.6±0.6)L·min-1·m-2,(124±22)mmHg,(16.7±3.6)mmHg,(11±4)mmHg。肱动脉舒张压则没有明显差异。两者刺激阈值、感知阈值、阻抗等起搏参数均无显著差别。结论右心室流出道起搏与传统的右心室心尖部起搏相比,可显著改善血流动力学;螺旋电极在右心室流出道的起搏参数满意。Objectives The aim of the study was to evaluate the hemodynamic effects of right ventricular outflow tract (RVOT) pacing by comparing with right ventricular apex (RVA) pacing, and to investigate practicability of RVOT pacing with screw-in leads to some extent. Methods Acute hemodynamic parameters were measured in 52 patients during pacing at RVA or RVOT sequently, and acute pacing parameters were also surveyed in this study. Results Acute hemodynamic improvement was observed in RVOT pacing compared with RVA pacing:cardiac output(CO), cardiac index(CI) and systolic blood pressure(SBP) increased by 13.59% (6.18±1.16 vs 7.02±1.40 L/min,P<0.05), 13.65% (3.59±0.65 vs 4.08±0.81 L/min/m2,P<0.01)and 4.78% (124.38±21.87 vs 130.32±20.77mmHg,P<0.05)respectively,mean pulmonary aterial pressure (mPAP) and pulmonary capillary wedge pressure(PCWP)decreased by 15.44%( 16.71±3.64 vs 14.13±3.16 mm Hg,P<0.01) and 25.14%(10.82±3.63 vs 8.10±3.42 mmHg,P<0.01)respectively. Acute capture thresholds had no significant difference between RVOT pacing and RVA pacing. Conclusions RVOT pacing may significantly improve acute hemodynamic parameters, and its pacing parameters is also satisfactory.

关 键 词：心脏起搏 右心室流出道 血流动力学 

分 类 号：R541.4[医药卫生—心血管疾病]