不同部位起搏对三度房室传导阻滞犬急性血流动力学的影响  

Influence of different site pacing on acute hemodynamics in dogs with third degree atrioventricular block

作　　者：安斌[1] 张丽晖[1] 王睿[1] 吴磊[1] 牛拴成[1] 相锐[1] 冯丽[1] 张佳斌[1] 张丽利[1] 相杰 李学文[1] 

机构地区：[1]山西省晋城市晋煤集团总医院心内科,048006

出　　处：《中华心脏与心律电子杂志》2015年第3期27-30,共4页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

摘　　要：目的探讨有心室心尖部(RVa)、左心室心尖部(LVa)和双心室(BiV)等不同部位起搏对三度房室传导阻滞犬急性血流动力学的影响。方法选取成年健康犬15只,行房室结射频消融制作三度房室传导阻滞犬模型。之后经股动静脉分别置入心室起搏电极并进行RVa、LVa、BiV 3个部位起搏,对心电图及血流动力学改变进行记录比较。不同位点起搏之间及与起搏前水平比较采用单变量双因素方差分析,组间采用Bonferroni法进行比较。结果 RVa、LVa、BiV 3个部位起搏下的QRS波宽度(QRSd)分别为(93±8)ms、(95±8)ms、(74±9)ms,其中以BiV起搏下最短(F=6.601,P<0.001)。LVdp/dtmax分别(5.0±0.7)mmHg/ms、(5.9±0.5)mmHg/ms、(6.1±1.5)mmHg/ms,其中LVa及BiV起搏时均高于RVa起搏(F=4.798,P=0.001)。结论与RVa起搏相比,BiV起搏能够提高心室同步性,改善左心室收缩功能;LVa起搏下虽然心室同步性与RVa起搏无差别,但仍能够改善左心室功能。Objective To investigate the influence of different site pacing （ RVa, LVa and BiV） on acute hemodynamics in dogs with third degree atrioventricular block （AVB）. Methods Adult health dogs （ n = 15 ） were chosen and given radiofrequency ablation （ RFA ） of atrioventricular node for establishing model of third degree AVB. The RVa pacing LVa pacing and BiV pacing were conducted through pacing electrodes implantation via femoral artery and vein. The changes of electrocardiogram （ECG） and hemodynamics were recorded and compared. The comparisons among different pacing modes and in level before pacing were analyzed by using univariate two-way ANOVA, and changes among groups were compared by using Bonferroni method. Results QRS duration （QRSd） was （ 93 ± 8 ） ms in RVa pacing, （ 95± 8） ms in LVa pacing and （74 ±9） ms in BiV pacing, and that was the shortest in BiV pacing （F=6. 601, P 〈 0. 001 ）. LVdp/dtmax was respectively （5.0 ± 0.7 ） mmHg/ms, （ 5.9 ± 0.5 ） mmHg/ms and （ 6.1 ±1.5） mmHg/ms, and that was higher in LVa pacing or BiV pacing than that in RVa pacing （ F = 4. 798, P =0.001 ）. Conclusion Compared with RVa pacing, BiV pacing can improve ventricular synchronicity and left ventricular systolic function. Although the ventricular synchronicity of LVa pacing has no different compared with that of RVa, left ventricular function is also improved.

关 键 词：房室传导阻滞 心脏起搏 血流动力学 犬 

分 类 号：R541.7[医药卫生—心血管疾病]