右心室流出道间隔部螺旋电极起搏对血流动力学的影响  

The effect of RVOTS spiral electrode pacing on hemodynamics

作　　者：史玉露[1] 丁坤[1] 孙春启[1] 关欣[1] 

机构地区：[1]安徽省蚌埠市第二人民医院心血管内科,233000

出　　处：《淮海医药》2009年第3期193-195,共3页Journal of Huaihai Medicine

摘　　要：目的评价在房室顺序起搏治疗中,右心室流出道间隔部螺旋电极起搏对血流动力学的影响。方法20例植入DDD型起搏器的患者,按照心室电极的位置,随机分为右心室流出道间隔部螺旋电极起搏组(RVOTS组)和右心室心尖部起搏组(RVA组)。对2组患者术前、术后QRS波形态和宽度以及术前、术后3个月随访时左室射血分数(LVEF)进行比较。结果2组患者均成功植入房、室起搏电极导线和起搏器,随访期间无电极脱位和其他并发症发生。2组患者术前所测定的LVEF无显著性差异;与术前相比,RVOTS组起搏QRS时限无明显变化,而RVA组较术前及RVOTS组显著延长。术后3个月随访,RVOTS组LVEF较术前无明显变化,而RVA组LVEF较术前下降,RVA组和RVOTS组相比,LVEF显著下降。结论RVA起搏使左、右心室不同步,对血流动力学产生不良影响,而RVOTS起搏尽可能地维持了双心室的正常激动顺序和双心室的同步性,对血流动力学的影响较小,RVOTS起搏比RVA起搏更接近生理性起搏。Objective To evaluate the effect of RVOTS spiral electrode pacing on hemodynamics in the treatment by atrioventricular sequential pacing. Methods Twenty cases implanted with DDD pace-maker were randomly divided into RVOTS group, which was paced by spiral electrode from the right ventricular outflow tract septum, and RVA group, paced from the right ventricular apex, according to the position of ventricular electrode. Comparison was conducted as regards the two groups＇QRS pattern and width before and after the operation as well as the left ventricular systolic function （ LVEF ） before the operation and three months＇follow-up. Results The two groups were both successfully implanted with atrial and ventricular pacing electrode wire and pace-maker. No dropping of electrode and other complications occurred during the follow-up period. There was no remarkable difference of the two groups＇LVEF compared with that before the operation. The RVOTS group＇s QRS pacing time showed no obvious change but the RVA group＇s was significantly longer than the RVOTS group＇s and than before the operation. In the three months＇follow-up, the LVEF of the RVOTS group indicated little change while the RVA group＇s LVEF was lower than before the operation. Compared with the RVOTS group, the LVEF of the RVA group decreased significantly. Conclusion RVA pacing causes non-synchronization of the left and right ventricles and thus produces bad hemodynamical effect. In contrast, RVOTS pacing can maintain the two ventricles＇normal pacing order and their synchronization and thus hemodynamically affect blood stream little. Thus RVOTS pacing is more physiologically acceptable than RVA pacing.

关 键 词：螺旋电极 右心室流出道间隔部 右心室心尖部 血流动力学 心脏起搏器 

分 类 号：R654.2[医药卫生—外科学]