多部位起搏的急性血流动力学对比研究  

A Comparative Study of the Acute Hemodynamic Effects of Multi-Site Pacing

作　　者：朱参战[1] 崔长琮[1] 张全发[1] 薛小临[1] 傅文[1] 刘维维 刘引会 徐琳[2] 

机构地区：[1]西安交通大学第一医院心内科,陕西省西安市710061 [2]西安交通大学第一医院心导管室,陕西省西安市710061

出　　处：《中国循环杂志》2002年第2期127-129,共3页Chinese Circulation Journal

摘　　要：目的 :比较右心室双部位起搏、双心室同步起搏、右心室心尖部起搏、右心室流出道起搏、左心室基底部起搏等 5种不同起搏模式对血流动力学的影响。方法 :15例患者男 10例 ,女 5例 ,年龄 6 6± 6 4岁。其中病态窦房结综合征 8例 ;Ⅲ度房室传导阻滞 7例。分别行右心室心尖部、右心室流出道、右心室双部位起搏、左心室基底部及双心室同步起搏 (VVI ,6 0～ 90次 /分 ) ,测定心输出量(CO)、心脏指数 (CI)、肺毛细血管嵌顿压 (PCWP)、QRS波群宽度和电轴。结果 :①与右心室心尖部起搏相比 ,右心室流出道、右心室双部位、左心室基底部、双心室同步起搏的CO、CI显著增加 ,PCWP明显降低 (P均 <0 0 1) ;②右心室双部位、双心室同步起搏较右心室流出道、左心室基底部起搏的CO、CI增高而PCWP降低 (P均 <0 0 5 ) ;③右心室双部位与双心室同步起搏、右心室流出道与左心室基底部起搏之间CO、CI和PCWP无显著差异 ;④右心室双部位、双心室同步起搏的QRS波群宽度较右心室心尖部、右心室流出道、左心室基底部起搏显著缩短 (P均 <0 0 1) ,而左心室基底部起搏与右心室心尖部起搏间无显著差异。结论 :右心室双部位起搏和双心室同步起搏的急性血流动力学效果无明显差异 ,但双部位起搏的效果明显优于单部位起搏 ;Objective: To compare the acute hemodynamic effects associated with the respective pacing of the right ventricular apex (RVA), right ventricular outflow tract (RVOT) and the left ventricular base (LVB), and the simultaneous pacing of the RVA and RVOT together with the RVA and LVB. Methods: Fifteen patients [66±6.4yrs, 10 men; 8 with sick sinus syndrome(SSS), 7 with Ⅲ°atrioventricular block(AVB)] underwent pacemaker implantation in this study. The left ventricle was paced through a coronary sinus tributary. RVA, RVOT, right ventricular bifocal(RV-Bi), LVB and bi-ventricular (Bi-V) pacing at 60-90 bpm were done prior to implantation of DDD pacemaker in VVI mode. The CO, CI, and pulmonary capillary wedge pressure(PCWP)were measured by Swan-Ganz thermodilution catheter. Electrocardiogram(ECG) was recorded at 50 mm/s for the detection of QRS duration (QRSd) and QRS axis. Results: ① Compared to RVA pacing, CO and CI were increased and PCWP was decreased significantly when pacing at RVOT, LVB or RV-Bi (p<0.01), respectively. ② CO and CI at RV-Bi and Bi-V pacing were higher than those at RVOT and LVB pacing. PCWP was lower than that at RVOT and LVB pacing(p<0.05), respectively. ③ There was no significant difference between RV-Bi pacing and Bi-V pacing in CO, CI and PCWP. ④ The QRSd of RV-Bi and Bi-V pacing were significant shortened compared with RVA, RVOT and LVB pacing (p<0.01). But there was no significant difference between LVB pacing and RVA pacing. Conclusion: There is no significant difference between RV-Bi pacing and Bi-V pacing. However the acute hemodynamic effects of dual sites pacing are much better than those of single site pacing. In addition, QRSd during dual sites pacing is significant shorter than that of single site pacing.

关 键 词：多部位起搏 急性血流动力学 对比研究 QRS波群宽度 右心室双部位起搏 双心室同步起搏 心电图 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]