右室双部位起搏的急性血流动力学研究  

The study of the acute hemodynamic effects of right ventricular bifocal pacing

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

机构地区：[1]西安交通大学第一医院心内科,西安710061

出　　处：《临床心血管病杂志》2002年第5期195-197,共3页Journal of Clinical Cardiology

摘　　要：目的 :比较右室双部位 (RV Bi)起搏与右室心尖部 (RVA)、右室流出道 (RVOT)起搏对急性血流动力学的影响。方法 :对 15例患者 (其中病态窦房结综合征 8例 ;三度房室传导阻滞 7例 )。分别行RVA、RVOT、RV Bi起搏 (VVI ,6 0～ 90次 /min) ,测定心排血量 (CO)和心排血指数 (CI)、平均肺动脉压 (mPAP)和肺毛细血管嵌顿压 (PCWP) ,QRS宽度 (QRSd)和电轴 (QRSa)。结果 :RV Bi起搏较RVOT、RVA起搏CO、CI明显增加 ,均P<0 .0 1;PCWP显著降低 ,为P <0 .0 5～ 0 .0 1;3个不同部位起搏mPAP无明显变化 ;RV Bi起搏较RVOT起搏的QRS波时限平均缩短 17ms,较RVA平均缩短了 35ms ,均P <0 .0 1。结论 :RV Bi起搏的急性血流动力学效果明显优于RVOT ,RVA等单部位起搏。Objective:To assess the potential value of right ventricular bifocal (RV Bi) pacing and compare the acute hemodynamic effects associated with pacing the right ventricular apex (RVA) and outflow tract (RVOT) alone, pacing the RVA and RVOT together (RV Bi).Method: This study included 15 patients who underwent pacemaker implantation. RVA, RVOT and RV Bi pacing at rate 60～90 ppm were done in VVI mode prior to permanent pacemaker implantation. The cardiac output (CO), cardiac index (CI), mean pulmonary artery pressure (mPAP) and pulmonary capillary wedgeing pressure (PCWP) were measured by Swan Ganz thermodilution catheter starting after 5 minutes of each pacing. ECG was recorded at 25 mm and 50 mm simultaneously for QRS duration (QRSd) detecting.Result: ①Comparing to RVA pacing (CO: 4.16 ± 0.51 ;CI: 2.39 ± 0.34 ; PCWP: 2.33 ± 0.49 ), the CO and CI increased and the PCWP decreased significantly when pacing at RVOT(CO: 4.42 ± 0.63 ; CI: 2.57 ± 0.45 ; PCWP: 1.98 ± 0.49 ) and RV Bi 〔CO:( 4.77 ± 0.69 ) L/min; CI:( 2.76 ± 0.53 ) L·min -1 ·m -2 ; PCWP:( 1.82 ± 0.41 ) kPa〕,P< 0.05 ～ 0.01 . ②The CO and CI of RV Bi pacing were higher than those of RVOT pacing (P< 0.01 ), whereas the PCWP was lower than that of RVOT pacing (P< 0.05 ). ③The QRSd of RVOT 〔(128±11) ms〕 and RV Bi pacing 〔(111±16) ms 〕was significant shortened compared to RVA pacing 〔(146±18) ms〕, P< 0.05 ～ 0.01 , and the QRSd of RV Bi pacing was the shortest.Conclusion: The acute hemodynamic effects of RV Bi pacing are much better than those of RVA and RVOT pacing. The QRSd during RV Bi pacing is significant shorter than that of RVA and RVOT pacing.

关 键 词：心脏起搏 多部位 血流动力学 人工起搏器 

分 类 号：R541[医药卫生—心血管疾病] R331.3[医药卫生—内科学]