双腔起搏治疗肥厚型梗阻性心肌病的临床应用及血液动力学评价  

Evaluation of hemodynamic and clinical effects of dualchamber pacemaker in obstructive hypertrophic cardiomyopathy

作　　者：汤宝鹏[1] 程祖亨[1] 张爱伦[1] 马依彤[1] 汪师贞[1] 郭新贵[1] 王疆[1] 邹立华[1] 

机构地区：[1]新疆医学院第一附属医院心内科

出　　处：《中华心律失常学杂志》1999年第1期12-15,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的对１０例肥厚型梗阻性心肌病（ＨＯＣＭ）患者行双腔（ＤＤＤ）起搏器治疗，探讨不同ＡＶ间期的血液动力学效应，并对其长期疗效进行评价。方法经锁骨下静脉植入ＤＤＤ起搏器，并同时植入Ｓｗａｎ－Ｇａｎｚ导管及猪尾导管，测量不同ＡＶ间期的血液动力学指标，二维超声心动图测量超声形态学指标，并于起搏器植入后二年随访上述指标。结果所有患者临床症状及心功能明显改善，急性起搏时不同ＡＶ间期的血液动力学均有改善，而以ＡＶ间期为１００ｍｓ、１２０ｍｓ时最明显，左室流出道内径（ＬＶＯＴＤ）增宽，收缩期二尖瓣前向运动程度（ＳＡＭ）明显改善，而起搏后１年、２年随访与起搏后即刻相比，上述指标均无显著变化。结论ＤＤＤ起搏可做为药物难治性ＨＯＣＭ的一种有效方法。Objective To observe the hemodynamic effects of dual chamber pacing (DDD) at various AV intervals,and evaluate its long term effects in 10 patients with obstructive hypertrophic cardiomyopathy (HOCM) Methods DDD pacemaker was implanted via subclavian vein.A SwanGanz catheter and a Cordis endhole catheter were placed to measure the hemodynamic parameters,2dimensional Doppler echocardiography was performed to measure relevant parameters at various AV intervals of pacing.The abovementioned parameters were measured after one year and two years of pacing. Results The clinical symptoms and NYHA functional status of all patients were considerably improved.Hemodynamic effect was significantly improved in various AV intervals especially with 100 and 120 ms of AV intervals immediately after pacing,Left ventricular outflow tract dimension (LVOTD) increased and degree of systolic anterior movement of mitral valve (SAM) improved significantly.After 1 year and 2 years of DDD pacing,the abovementioned parameters were not significantly different as compared with that in acute postpacing period. Conclusion DDD pacing is an effective form of therapy in patients with drugresistant HOCM.

关 键 词：双腔起搏器 肥厚型 梗阻性 心肌病 血液动力学 

分 类 号：R654.205[医药卫生—外科学] R542.205[医药卫生—临床医学]