右心室不同部位起搏对心脏收缩同步性的影响  

Effects on cardiac synchronization motion with DDD pacing mode at variant right ventricular pacing sites

作　　者：王品晓[1] 林加锋[1] 季亢挺[1] 李嘉[1] 孙海燕[2] 兰华仙[3] 金戈[1] 殷日鹏[1] 

机构地区：[1]温州医学院附属第二医院心内科,325027 [2]温州医学院附属第二医院超声科,325027 [3]温州医学院附属第二医院心电图室,325027

出　　处：《浙江医学》2012年第10期789-792,797,共5页Zhejiang Medical Journal

摘　　要：目的 探讨病态窦房结综合征（SSS）患者分别在右心室流出道间隔部（RVOT）和右心室心尖部（RVA）植入永久性心室起搏导线前后各项心功能指标是否存在差异,比较各项指标的敏感性.方法 选取SSS患者60 例,随机分为RVOT 组和RVA组,均植入DDD永久性起搏器.所有患者术前及术后1、3、6 个月进行心电图检查,测量QRS 时限;超声心动图测量左心室舒张末期内径（LVEDD）、左心室射血分数（EF）、左右室射血前期时间延迟（PETd）;实时三维超声心动图（RT-3DE）分别检测左心室16、12 节段达到最小收缩容积时间的标准偏差（Tmsv16-SD、Tmsv12-SD）及心率校正后的Tmsv16-SD/R-R、Tmsv12-SD/R-R 和左心室16 节段达到最小收缩容积时间的最大差值（Tmsv16-Dif）、心率校正后的Tmsv16-Dif/R-R 和左右心室间机械延迟（IVMD）;检测血NT-proBNP.结果 与术前比较,RVOT组术后1、3、6个月QRS 及IVMD 均显著升高（P＜0.01）;RVA组术后1、3、6 个月QRS、IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R、Tmsv16-dif、Tmsv16-dif/R-R 均显著升高（P＜0.01）,术后3、6 个月PETD 亦显著升高（P＜0.01）.与ROVT 组比较,术后1、3、6 个月时RVA 组IVMD、Tmsv16-SD、Tmsv12-SD、Tmsv16-SD/R-R、Tmsv12-SD/R-R Tmsv16-dif、Tmsv16-dif/R-R均明显升高（P＜0.05 或0.01）.结论 DDD 起搏后,无论是RVA 起搏还是RVOT起搏,均影响了心室运动的同步性;RVOT起搏对心室收缩同步性影响较RVA 小.实时三维超声心动图评价DDD 起搏术后患者心室运动的同步性优于传统的检测方法.Objective To investigate the effects of right ventricular apex （RVA）pacing and right ventricular outflow tract （RVOT） pacing on cardiac synchronization motion and cardiac function with DDD pacing mode in sick sinus syndrome （SSS） patients. Methods Sixty patients with SSS were randomly divided into two groups： in group A（n=30） the pacing wire was implant- ed in RVOT; in group B @=30） the wire was implanted in RVA. Patient in both groups underwent electrocardiogram and echocar- diography examinations before and 1, 3 and 6 months after the operation. The QRS duration, left ventricular end diastolic diame- ter （LVEDD）, left ventricular ejection fraction （LVEF） and pre-ejection time delay （PETd） were recorded and compared between two groups. Full volume real-time three-dimensional echocardiography （RT-3DE） was performed in two groups before and 1, 3 and 6 months after operation. The dispersion of time to minimum regional volume for 16 and 12 left ventricular segment （Tmsv 16-SD and Tmsv 12-SD）, and the maximum difference of time to minimum regional volume for 16 left ventricular segment （Tmsv 16-Dif）, interventricular mechanical delay （IVMD }were investigated. Meanwhile, plasma NT-proBNP levels were also measured. Results The LVEDD, EF and plasma NT-proBNP showed no changes after 1, 3 and 6 months of pacemaker treatment compared to those before treatment（P 〉0.05）. QRS duration was increased at 1, 3 and 6 month after operation（P〈0.01）; and there were no differences between two groups （P 〉0.05）. IVMD, Tmsv 16-SD, Tmsv 12-SD, Tmsv 16-Dif, Tmsv16-SD/R-R, Tmsv12-SD/R-R and Tmsv 16-Dif/R-R were significantly increased in group B at 1, 3 and 6 months after the operation（P〈0.01）. PETd showed no changes both in group A and group B （P 〉0.05） at 1 month after operation. The incident of PETd increased more markedly in group B than in group A at 3 and 6 months after treatment （P〈0.05, P〈0.01）; at the same time, only IVMD reflected interventricu- la

关 键 词：右室流出道间隔部 右室心尖部 病态窦房结综合征 同步性 实时三维超声心动图 

分 类 号：R541[医药卫生—心血管疾病]