右心室间隔部起搏和右心室心尖部起搏对血流动力学的影响  

Effects on hemodynamies of pacing in right ventricle septum and right ventricle apex

作　　者：周宁[1] 王琳[1] 吕加高[1] 杨晓云[1] 卜军[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,武汉430030

出　　处：《临床心血管病杂志》2006年第5期267-269,共3页Journal of Clinical Cardiology

摘　　要：目的:比较右心室间隔部(RVS)起搏和右心室心尖部(RVA)起搏对血流动力学的影响。方法:20 例置入DDD起搏器的患者,随机均分为2组,RVS组行RVS起搏,RVA组行RVA起搏;对比观察术前与术后心电图QRS波宽度和形态;比较2组术前和术后6个月随访的左室射血分数(LVEF)、心脏指数(CI)、每搏量 (SV)、二尖瓣血流E峰和A峰最大充盈速度比值(E／A)差异。结果:RVA组起搏心电图Ⅱ导联QRS时限度显著长于RVS组[(0．19±0．02)s:(0．12±0．02)s,P<0．01];术前2组LVEF、CI、SV和E／A均差异无统计学意义。与术前相比,RVA组6个月随访的LVEF、CI、SV和E／A均显著降低[(60．7±5．9)％:(54．8±6．4)％, (2．78±0．31):(2．49±0．26),(81．5±10．0):(68．6±12．5),(1．70±0．48):(1．20±0．39),均P<0．05], RVS组无明显变化[(62．7±6,4)％:(61．14±5．8)％,(2．74±0．33):(2．76±0．25),(82．2±9．2):(78．7±11． 5),(1．62±0．49):(1．61±0．40),均P>0．05]。6个月随访RVS组LVEF、CISV、SV、E／A均显著高于RVA 组(均P<0．05)。结论:RVA起搏扰乱了双心室电同步,导致血流动力学恶化,RVS起搏则尽可能地保证了双心室正常电激动和机械收缩顺序,对血流动力学无不良影响。Objective; To compare the effects on hemodynamics of pacing in right ventricular septum and in right ventrieular apex. Method： Twenty patients performed with DDD pacing were grouped randomly into two terms, one group including 10 patients received RVS pacing while 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 were compared among preoperation, the moment of pacing and 6 months after operation. Result：The QR$ duration of lead Ⅱof RVA group was longer than RVS group dramatically （[0.19±0.02]s vs[0.12±0.02]s, P d0.01） ;There were no differences on LVEF, CISV, E/A of the two groups before operation（ P〉0.05）. Compared with the hemodynamics of the preoperation, The LVEF, CI,SV, E/A of the RVA groups of 6 months after operation decreased significantly （60.7±5.9） ; （54.8±6.4）,（2.78±0.31） ： （2.49±0.26）, （81.5± 10.0） ： （68.6±12.5）, （1.70 ± 0.48） ： （1.20 ± 0.39）, P 〈0.05, while RVA groups didn＇t change statistically （62.7 ± 6. 4）% ： （61.1±5.8）%,（2.74±0.33） ; （2.76±0.25）,（82.2±9.2） ; （78.7±11.5）,（1.62±0.49） ： （1.61± 0.40）, P 〉0.05. The LVEF, SV, FV and EV of RVS groups were higher than RVA groups significantly at the follow-up of 6 months （ P 〈0.05）. Conclusion： The RVA pacing disturbs the biventricular electrical synchrony and results in the deterioration of the hemodynamics. The RVS pacing farthest keeps the normal sequence of electrical activity and contraction and has no negative effect on the hemodynamics.

关 键 词：心脏起搏 人工 右心室 超声心动描记术 血流动力学 

分 类 号：R540.4[医药卫生—心血管疾病]