组织多普勒成像评价右心室心尖部与右心室流出道间隔部起搏对心功能的影响  

Effect of right ventricular outflow tract pacing and right ventricular apex pacing on cardiac function by tissue Doppler imaging

作　　者：卜婕[1] 俞杉[1] 吴强[1] 安亚平[1] 

机构地区：[1]贵州省人民医院心内科,贵州贵阳550002

出　　处：《临床荟萃》2011年第7期575-578,共4页Clinical Focus

基　　金：贵州省优秀科技教育人才省长专项资金项目(200899)

摘　　要：目的运用组织多普勒成像技术(TDI)比较右心室流出道(RVOT)间隔部起搏和右心室心尖部(RVA)起搏对心功能的影响。方法将缓慢心律失常患者65例随机分为RVA起搏组(n=30)、RVOT起搏组(n=35)。于起搏器置入术前、术后1个月、3个月、6个月及12个月分别采用组织多普勒速度-时间曲线测量二尖瓣环舒张早期运动速度(Ea)、收缩期运动速度(Sa)、Tei指数;采用SIMPSON法测量左心室射血分数(LVEF);采用脉冲多普勒测定二尖瓣口舒张早期最大血流速度(E),并计算E与Ea比值(E/Ea)。结果 RVA与RVOT两组术前与术后1、3个月的各项指标差异均无统计学意义;术后1、3个月LVEF(61.89±3.37)%vs(61.51±3.11)%,(60.22±4.85)%vs(60.32±4.25)%,Sa(11.38±1.14)cm/s vs(11.44±2.14),(10.88±1.91)cm/s vs(11.02±1.31)cm/s,E/A 0.96±0.19 vs 0.97±0.23,0.95±0.15 vs 0.96±0.13,E/Ea 8.8±3.6 vs 8.4±4.3,9.1±4.3 vs 8.8±3.2,Tei指数0.48±0.05 vs 0.47±0.08,0.50±0.20 vs 0.47±0.11(均P>0.05);术后6个月时RVA起搏组与RVOT起搏组比较,Tei指数及E/Ea增高(0.76±0.26 vs 0.67±0.32,10.9±3.96 vs 9.0±2.8,均P<0.05),术后12个月Sa降低,(8.22±1.72)cm/s vs(9.52±2.56)cm/s(P<0.05)。结论 RVA起搏引起心脏收缩不同步,从而损害左心室收缩和舒张功能。RVOT间隔部可获得较RVA起搏更为优化的心功能参数,是较好的右心室起搏部位。Objective To explore the effects of right ventricular apex（RVA） pacing and right ventricular outflow tract（RVOT） pacing on cardiac function using tissue Doppler imaging technique.Methods 65 lentitude arrhythmia patients were randomly divided into RVA pacing group（n=30）,RVOT pacing group（n=35）.Before the pacemaker implantation,after 1 month,3 months,6 months and 12 months respectively,early diastolic mitral annulus velocity（Ea）,systolic velocity（Sa）,Tei index were measured by tissue velocity-time curve;left ventricular ejection fraction（LVEF） was measured by SIMPSON method;mitral early diastolic peak velocity（E） was measured by pulsed Doppler,E,E and Ea ratio（E/Ea） were calculated.Results RVA and RVOT both groups before and after 1,3 months,all the indicators were not statistically significant.After 1,3 months in the above two groups,LVEF was respectively（61.89±3.37）% vs（61.51±3.11）%,（60.22±4.85）% vs（60.32±4.25）%,Sa（11.38±1.14） cm/s vs（11.44±2.14） cm/s,（10.88±1.91） cm/s vs（11.02±1.31） cm/s,E/A 0.96±0.19 vs 0.97±0.23,0.95±0.15 vs 0.96±0.13,E/Ea 8.8±3.6 vs 8.4±4.3,9.1±4.3 vs 8.8±3.2,Tei index 0.48±0.05 vs 0.47±0.08,0.50±0.20 vs 0.47±0.11（all P0.05）.After 6 months,RVA pacing and RVOT pacing compared with tissue Doppler indexes,Tei index and E/Ea increased 0.76±0.26 vs 0.67±0.32,10.9±3.96 vs 9.0±2.8,all P0.05）,after 12 months,Sa decreased,（8.22±1.72） cm/s vs（9.52±2.56） cm/s（P0.05）.Conclusion RVA pacing induced heart contractions are not synchronized to the detriment of left ventricular systolic and diastolic function.RVOT septal pacing obtains more optimal parameters of heart function than RVA pacing,and RVOT septal pacing is a good right ventricular pacing site.

关 键 词：冠状动脉疾病 心脏起搏 人工 超声心动描记术 多普勒 彩色 

分 类 号：R541.4[医药卫生—心血管疾病]