经胸植入左心室心外膜永久起搏器治疗儿童完全性房室传导阻滞、完全性左束支传导阻滞的疗效及心脏同步性研究  

Investigation into efficacy and synchronization of permanent left ventricular epicardial pacing through left lateral thoracotomy in treatment of children with complete atrioventricular block or complete left bundle branch block

作　　者：刘海菊[1] 李小梅[1] 崔建[2] 徐忠华[1] 马雪静[2] 江河[1] 

机构地区：[1]清华大学医学中心,清华大学第一附属医院心脏中心小儿科,北京100016 [2]清华大学医学中心,清华大学第一附属医院心脏中心彩超室,北京100016

出　　处：《中华实用儿科临床杂志》2016年第23期1787-1791,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨经胸植入左心室心外膜永久起搏器治疗儿童完全性房室传导阻滞（CAVB）、完全性左束支传导阻滞（CLBBB）的效果及对心脏同步性的影响。 方法选择因CAVB和CLBBB在清华大学第一附属医院心脏中心接受左心室心外膜永久起搏器植入的患儿26例。年龄（2.3±2.1）岁（1个月～9岁）；体质量（11.2±5.8） kg（5～32 kg）；其中男15例，女11例；CAVB 24例，CLBBB所致扩张型心肌病2例。纳入15例年龄相仿的因＂急性上呼吸道感染＂于儿科门诊就诊的患儿作为对照组。分析26例患儿植入左心室心外膜起搏器的效果，采用组织多普勒超声心动图评估其对心脏同步性的影响。 结果26例患儿植入左心室心外膜起搏器均获成功，其中21例植入左心房、左心室心外膜双腔起搏器，5例植入左心室心外膜单腔起搏器，无手术并发症发生。随访（28.2±15.1）个月（1～51个月），全部心房电极及心室电极有效率为100%。心房电极感知、心室电极阈值和心室电极阻抗较术中差异无统计学意义（P〉0.05）。6例植入前存在心功能不全患儿，左心室舒张末内径由术前（48.50±11.10） mm缩小至（40.67±6.40） mm，差异有统计学意义（t＝2.96，P＝0.030）；射血分数（LVEF）由术前0.27±0.08提高至0.53±0.08，差异有统计学意义（t＝－5.02，P＝0.004）。2例右心室永久起搏患儿，出现起搏器综合征，经更换为左心室心外膜起搏后分别于术后1.5年、2.0年心功能恢复正常。术后行组织多普勒超声心动图评估心脏同步性者15例，与对照组比较，LVEF、室间隔-侧壁运动延迟时间、室间隔至左心室后壁运动延迟时间及左心室内收缩不同步指数2组间差异均无统计学意义（P均〉0.05）。结论在需要接受心外膜起搏器治疗的儿童中，左心室心外膜起搏器安全有效，可保护左心室心肌收缩同步性，避免或逆转起搏�ObjectiveTo investigate the efficacy of permanent left ventricular epicardial pacing through left lateral thoracotomy in children with complete atrioventricular block（CAVB） or complete left bundle branch block （CLBBB） as well as its effects on heart synchronization.MethodsPermanent left ventricular epicardial pacemakers were implanted through left lateral thoracotomy in 26 children with CAVB or CLBBB in Heart Center, the First Affiliated Hospital of Tsinghua University.These children aged （2.3±2.1） years old （1 month-9 years old）, weight （11.2±5.8） kg （5-32 kg）, among them 15 cases were male and 11 cases were female.Among the 26 patients, 24 patients had CAVB and 2 patients had dilated cardiomyopathy secondary to CLBBB.Fifteen children who visited the Pediatrics Department for acute upper respiratory tract infection were chosen as control group.The efficacy of left ventricular epicardial pacemakers was analyzed and its effects on heart synchronization were observed by using tissue Doppler imaging（TDI）.ResultsImplantations of pacemakers were successfully conducted in all the 26 patients with no complications associated with operations.Left atrial and ventricular dual chamber epicardial pacemakers were implanted in 21 patients and left ventricular single chamber epicardial pacemakers were implanted in 5 patients.Within the follow-up period of （28.2±15.1） months （1 month-51 months）, atrial and ventricular leads were 100% effective.No significant diffe-rence was found in atrial electrode sensing, ventricular electrode threshold and ventricular electrode impedance compared with those during implantation（P〉0.05）. For the 6 patients with preoperative cardiac insufficiency, their left ventricular diastolic diameters decreased from （48.50±11.10） mm to （40.67±6.40） mm after operation, and the difference was significant （t=2.96, P=0.030）; but left ventricular ejection fraction increased from 0.27±0.08 to 0.53±0.08 after operation, and the difference was significan

关 键 词：左心室心外膜起搏 起搏器综合征 儿童 心室间同步性 左心室内同步性 

分 类 号：R725.4[医药卫生—儿科]