围术期右室流入道间隔部起搏对三尖瓣返流的影响  

Influence of right ventricular inlet septum pacing on tricuspid regurgitation during perioperative period

作　　者：邹宝明[1] 王景武[1] 孙克陆[1] 徐敏[1] 徐锋[1] 梁爱霞[1] 

机构地区：[1]解放军第105医院四病区(心内一科),合肥市230031

出　　处：《中华全科医学》2015年第6期896-898,共3页Chinese Journal of General Practice

摘　　要：目的右室起搏对三尖瓣功能的影响情况一直不明,故本研究旨在观察围术期右室流入道间隔部(RVIS)起搏这一新的起搏部位对三尖瓣返流的影响。方法所有入选病例均经全面检查,诊断明确,药物治疗无效,符合永久起搏器植入的Ⅰ类或Ⅱa类指征,电极置于右室流入道间隔部,经胸透及心电图确定电极位置。正常起搏时,采用美国Acuson Sequoia 512超声诊断仪检测三尖瓣返流面积、肺动脉峰流速,5个连续稳定心动周期取均值,根据三尖瓣返流面积将患者分为2组:轻度(返流面积≤3.0 cm2)和中度(返流面积>3.0 cm2、≤7.0 cm2)。在有效起搏时,脉宽0.5 ms,输出5 V的状态下,采用起搏器程控仪检测起搏阻抗和起搏阈电压;比较围术期RVIS与心尖部(RVA)起搏时三尖瓣返流面积(TRA)、肺动脉峰流速(Vpk P)及起搏阻抗、起搏阈电压的变化。采用SPSS 17.0软件进行统计学分析。结果 12组患者围术期内肺动脉峰流速无明显变化(P>0.05);2起搏参数:2组患者围术后期起搏阻抗均有增加(P<0.05),RVIS组早期阻抗明显低于RVA组(P<0.05);2组患者起搏阈电压变化不明显(P>0.05);3三尖瓣返流面积:RVIS组轻度患者围术后期返流面积明显减少(2.66±0.35vs.1.78±0.43,P<0.05),中度返流患者及RVA组无明显变化(P>0.05)。结论右室流入道间隔部起搏可有效改善轻度三尖瓣返流,对中度返流影响不明显。Objective To discuss the influence of the right ventricular inlet septum（RVIS） pacing on the tricuspid regur- gitation in perioperative period. Methods All the patients with Class Ⅰ or Ⅱ a indications for permanent pacemaker im- plantation. The pacing electrode was implanted at the right ventricular inlet septum （ RV inlet septum, RVIS ） and con- firmed by chest X-ray and ECG. Under the pacing, tricuspid regurgitation area （TRA） and pulmonary artery flow velocity （VpkP） was detected using uhrasonic diagnostic instrument,the mean value was averaged for 5 cardiac cycles. The pa- tients were divided into mild regurgitation group （ regurgitation area equal to or less than 3.0 cm2 ） and moderate regurgi- tation group （ regurgitation area more than 3.0 cm2 but equal to or less than 7.0 cm2 ） according to tricuspid regurgitation area. At effective pacing strategy, the pacing impedance and pacing threshold voltage were controlled by pacemaker moni- tors （ pulse width 0.5 ms,5 V output）. The perioperative tricuspid regurgitation area, pulmonary artery flow velocity, pa- cing impedance and pacing threshold voltage were compared between RVIS and right ventricular apex（RVA） pacing. The data was analyzed using SPSS 17.0 software. Results ①The pulmonary artery flow velocity was not obvious change in both groups during perioperative period（ P 〉 0.05 ）. ②Pacing parameter： The electrode impedance were increased signifi- cantly in perioperative end period in both groups（ P 〈 0.05 ）. Compare two groups, the early phase electrode impedance was lower in RVIS pacing group （ P 〈 0.05 ）. The pacing voltage threshold was no obvious change in both groups （ P 〉 0.05 ）. ③Tficuspid regurgitation area（TRA） ：TRA of the mild patient were decreased significantly in perioperative end period in RVIS pacing group （ 2.66 ± 0.35 vs. 1.78 ± 0.43, P 〈 0.05 ）. TRA of the moderate patient was no obvious change in RVIS pacing groups （P 〉 0.05 ）. There was no obviously

关 键 词：心脏起搏 人工 右心室流入道间隔部 三尖瓣返流 

分 类 号：R54[医药卫生—心血管疾病] R654.2[医药卫生—内科学]