心脏选择性部位起搏的电和机械同步性研究的初步报告  

Report on initiating clinical research for electrical and mechanical synchronism of selective region pacing in the right ventricular

作　　者：蔡琳[1] 黄德嘉[1] 燕纯伯[1] 饶莉[1] 刘剑雄[1] 刘汉雄[1] 

机构地区：[1]四川大学华西医院心内科,成都610041

出　　处：《中华心血管病杂志》2007年第2期147-150,共4页Chinese Journal of Cardiology

摘　　要：目的观察心脏不同部位起搏时的电及机械同步性和血流动力学变化。方法 14例患者分别于右室心尖(RVA)、希氏束部位(His)、右室高位流出道间隔部(RVOT)起搏,记录心输出量和心脏指数;比较不同部位起搏和自身心律时12导联体表心电图的 QRS 波宽度和方向,以评价电同步性;用全数字化超声诊断系统的向量速度显像评价机械同步性。结果心输出量和心脏指数在RVA 起搏时较差,但差异无统计学意义(P>0.05)。各部位起搏时 QRS 波的宽度:His 为(124±5.3)ms,RVOT(144±7.1)ms,RVA(156±8.6)ms,均较自身心律(92±4.5)ms 时宽(P<0.01);而His 及 RVOT 均较 RVA 起搏时的 QRS 波时限窄,其差异有统计学意义(P<0.01)。向量速度显像检查提示,RVOT 起搏相对于 RVA 起搏有更好的机械同步性。结论 RVOT 可能较传统的 RVA 部位起搏好,同时手术操作容易。Objective To verify the electric synchronism, mechanic synchronism and hemedynamics of selective site pacing. Methods Pacing in the right ventricular cardiac apex （ RVA）, the right ventricular His bundle region （His） , and the septum of right ventricular high-positioned outflow tract （RVOT）, CO and CI were recorded. The electrical synchronism was assessed by observing the width and shape in a 12-lead surface ECG . The mechanical synchronism was estimated by using the VVI （vector velocity imaging） technology of the Acuson Sequia 512. Results The results showed that CO and CI were lower while pacing in RVA, but they were not significant different （P 〉0.05）. The QRS width： （ 124 ±5.3 ） ms while pacing in His, （ 144 ± 7. 1 ） ms while pacing in RVOT and （ 156 ± 8.6） ms while pacing in RVA. The QRS width while pacing in His and in RVOT were narrower than in RVA and there were significant differences （P 〈 0. 01 ）. Vector velocity imaging showed that mechanical synchronism was better while pacing in RVOT than that in RVA. Conclusion Pacing in RVOT seems better than pacing in traditional RVA, and the operation was no more difficult than the traditional operation.

关 键 词：心脏起搏 人工 心脏功能试验 血液动力学 

分 类 号：R541.7[医药卫生—心血管疾病]