右室流出道间隔部起搏电极定位方法的临床研究  

The electrode positioning skills at septum of right ventricular outflow tract

作　　者：樊济海[1] 巢胜吾[1] 顾秀莲[1] 王玲[1] 潘瑞麟[1] 

机构地区：[1]解放军第四五五医院心内科,上海200052

出　　处：《中国心脏起搏与心电生理杂志》2007年第1期17-19,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨右室流出道(RVOT)间隔部位起搏的电极定位操作方法。方法具备心脏永久起搏指征的患者(n=40),随机分为A、B两组,每组20例。根据右室解剖学特征,设计了双弯曲导线指引导丝塑型,比较应用该塑型指引导丝(B组)与常规单个弯曲塑型指引导丝(A组)在RVOT间隔部起搏术中操控主动固定电极中应用效果。结果起搏阈值、导线电极阻抗无显著差异,感知R波振幅B组较A组低(12.32±3.80mVvs9.28±3.34mV,P=0.037);电极定位操作X线曝光时间A组大于B组(23.29±9.23minvs12.85±5.82min,P=0.002),电极固定次数A组大于B组(2.64±1.22次vs1.62±0.77次,P=0.015)。两组RVOT间隔部定位成功率:A组14/20(70%),B组18/20(90%),但未显示统计学差异;RVOT间隔部失败者均固定于低位间隔部。术后3个月内仅A组1例导线脱位。结论RVOT间隔部电极定位双弯曲指引导丝支撑下操作,减少X线曝光时间和电极固定次数,比单弯曲指引导丝方法更加简单化。两种方法均安全、稳定。Objective To explore the electrode positioning skills of septum in right ventricular outflow tract （RVOT）. Method Patients with indications for cardiac pacing （n = 40） were randomized into two groups. A double- curve guiding wire designed referring to anatomy of right ventricle was used in group B （n = 20）, and normal mono-curve guiding wire was used in group A（ n = 20）. The results between the two groups were compared. Results There were not significant differences in the pacing threshold and the electrode impedance. The sensing thresholds were lower in group B than in group A （ 12.32 ± 3.80 mV vs 9.28 ± 3.34 mV, P = 0. 173 ）. The rates of successful RVOT location were 14/20 （70%） in group A vs 18/20 （90%） in group B and also no difference statistically （P〉0.05）. While there were significant differences in X-ray exposing time （23.29 ± 9.23 min vs 12.85 ± 5.82 min,P = 0.002） and electrode fixing frequency （2.64 ± 1.22 times vs 1.62 ± 0.77 times,P = 0. 015 ） between group A and B. Complication happened in only one patient in group A who experienced loose electrode placement two month later and was reoperated successfully. Conclusion The operations of electrode location in RVOT septum pacing might be much easier with using the double-curve guiding wire than using the mono-curve guiding wire and also with shorter X ray exposing time and less electrode fixing frequency. Both methods showed good safety and stability.

关 键 词：心血管病学 心脏起搏 右室流出道 心室间隔 起搏电极 

分 类 号：R318.11[医药卫生—生物医学工程]