起搏器治疗中选择不同部位电极起搏对心肌运动协调性的影响  

Influences on myocardial coordination when cardiac pacing on different spots in therapy with pacemaker

作　　者：问肃生 商鸿[1] 雷晓亭 洪志斌[1] 魏小红[1] 

机构地区：[1]甘肃省天水市第一人民医院心内科,甘肃天水741000

出　　处：《第四军医大学学报》2009年第24期3120-3122,共3页Journal of the Fourth Military Medical University

摘　　要：目的:观察起搏器治疗中选择不同部位电极起搏对心肌运动协调性的影响.方法:对接受起搏器治疗的48例患者,其中右室流出道起搏(RVOTP)28例,右室心尖部起搏(RVAP)20例,利用组织多普勒速度图对接受起搏器置入的患者,采集左室八个节段的心肌运动情况,测得各段心肌收缩运动达峰时间、心肌收缩时间和舒张期快速充盈达峰时间.从而了解不同部位电极起搏,对心肌运动协调性的影响.结果:RVOTP组与RVAP组患者比较,起搏器置入前收缩运动协调性的达峰时间无统计学差异,置入3～6mo后,RVOTP组协调性明显提高(P<0.01),而RVAP组协调性有所降低(P<0.01);置入后RVOTP组协调性明显高于RVAP组(P<0.01).代表舒张运动协调性的Q-E时间:置入3～6mo后,RVAP组舒张协调性明显低于RVOTP组(P<0.01).并且RVAP组置入后协调性有所降低(P<0.01).结论:使用螺旋电极选择理想部位起搏有利于心肌收缩运动的协调性.AIM：To observe the influences on myocardial coordination when pacing with electrode on different spots in therapy with pacemaker.METHODS：Using Tissue Doppler velocity,we observed the 48 patients who received pacemaker implantation,including 28 of right ventricular outflow tract pacing（RVOTP）and 20 of right ventricular apical pacing（RVAP）,collected data of the cardiac muscle movements of left ventricle during theirs eight stages.Each stage consists of：1.time-to-peak of myocardial contraction,2.time-to-peak of diastolic rapid filling,3.myocardial contraction time.With the data above we can get the influences on myocardial coordination when pacing with electrode on different spots.RESULTS：For patients in group RVOTP and RVAP,when comparing the time-to-peak of myocardial contraction,which reflect the coordination of myocardial contraction,we can conclude that：there was no significant difference between the two sets of data before pacemaker implantation,but 3 to 6 months later coordination of the RVOTP group markedly improved（P0.01）while that of the RVAP group declined （P0.01）,the coordination of the former obviously exceeded the latter（P0.01）.When comparing the time Q-E,which reflect the coordination of diastolic movement,we can conclude that：there was no significant difference between the two sets of data before pacemaker implantation,but the coordination of RVAP group declined after the period of 3 to 6 months （P0.01）and markedly below that of the RVOTP group（P0.01）.CONCLUSION：Using spiral electrodes to select the ideal pacing spots can be conducive to the coordination of myocardial contraction.

关 键 词：起搏器置入 不同部位起搏 心肌运动协调性 

分 类 号：R654.2[医药卫生—外科学]