右室流出道起搏对患者心脏血流动力学和心室激动顺序的影响  

Effects of pacing the right ventricular outflow tract on the cardiac hemodynamic and the ventricular activation sequence

作　　者：王国锋[1] 于波[2] 

机构地区：[1]中国医科大学附属第四医院心内科,沈阳110032 [2]中国医科大学附属第四医院附属第一医院心内科,沈阳110032

出　　处：《中国医师杂志》2011年第7期919-922,共4页Journal of Chinese Physician

摘　　要：目的通过与右室心尖部（RVA）起搏比较，探讨右室流出道（RVOT）起搏对血流动力学和心室激动顺序的影响。方法选择2006年10月至2008年9月因Ⅲ度房室传导阻滞或病态窦房结综合症于本院行DDD起搏器安置术的患者79例，根据心室电极置入位置不同分为右室心尖部起搏组38例，右室流出道起搏组41例。测量所有患者于术前、术后6个月，12个月，完全起搏时QRS波群平均时限，心脏指数（CI），左室射血分数（LVEF）、二尖瓣血流E峰和A峰最大充盈速度比值（E／A）差异。结果与术前相比，RVA组6个月，12个月随访的LVEF、CI、E／A未显著降低，RV-OT较RVA起搏时CI等血流动力学指标差异均无统计学意义（P〉0．05）。与正常窦性心律时QRS波时限比较，各部位起搏时QRS波时限均延长（P均〈0．05），RVA组起搏心电图Ⅱ导联QRS时限显著长于RVOT组（P均〈0．05）。结论RVOT和RVA起搏，在血流流动力学指标上较术前没有明显变化。RVOT和RVA起搏相比，能够保持相对正常的心室激动顺序。Objectives To compare the hemodynamic effects and ventricular activation sequence associated with the respective pacing of the right ventricular outflow tract （RVOT） and right ventricular apex （RVA）. Methods 79 patients with complete atrioventricular block （AVB）or sick sinus syndrome （SSS） to undergo permanent ventricular stimulation either at the right ventricular apex （ RVA ） （ n = 38） or right ventricular outflow tract （RVOT）（ n =41 ） were selected. The left ventricular ejection fraction （LVEF）, cardiac index （ CI）, mitral E/A ratio and QRS duration were recorded before implantation of pacemaker and 6 or 12 months after implantation. Results There were no significant differences in CI , LVEF, E/A between RVOT and RVA pacing（ P 〉 0. 05 ）. Compared with normal sinus rhythm, the QRS duration was significantly lengthened when pacing at RVOT or RVA （ P 〈 0.05）. RVA pacing was significantly longer than RVOT in QRS duration （ P 〈 0. 05）. Conclusions There was no significant difference with the hemodynamic effect between RVOT and RVA pacing in subject with normal heart function. Compared with RVA pacing, RVOT pacing remained relatively normal ventricular activation sequence.

关 键 词：心脏起搏 人工/方法 心室 血流动力学 房室传导阻滞/治疗 

分 类 号：R541.7[医药卫生—心血管疾病]