右心室不同部位起搏对心室同步性及心功能的影响  

作　　者：赵波[1] 谷惠敏[1] 李相权[1] 冯振勤[1] 赵志强[1] 

机构地区：[1]江苏大学附属昆山医院,215300

出　　处：《浙江临床医学》2017年第5期819-820,共2页Zhejiang Clinical Medical Journal

基　　金：江苏大学医学临床科技发展基金项目（JLY20120047）

摘　　要：目的应用组织多普勒成像技术比较右室心尖部起搏和右室流出道起搏对心室同步性及心功能的变化。方法因Ⅱ°及Ⅲ°房室传导阻滞患者接受DDD或VVI起搏治疗47例，分为右心室间隔部起搏组22例（RVOT组）和右心室心尖部起搏组25例（RVA组）。观察术前和禾后3、6个月时心电图QRs时限、左室射血分数、NT-pro-BNP、PPEI-APEI、Ts-SD和Tei指数，比较两组患者心室机械收缩同步性的差异并评价起搏对心功能影响。结果RVA组与RVOT组术后心电INQRS均较术前明显增宽（P〈0．01），RVA组比RVOT组增宽更为明显（P〈0．05）。RVA组与RVOT组在术后6个月比较，其Tei指数、NT-pro-BNP指标差异均有统计学意义（P〈0．05），提RVA起搏对心脏收缩和舒张功能均有明显影响。RVA组与RVOT组在术后3、6个月比较，APEI-PPEI、Ts-SD指标差异均有统计学意义（P〈0．05），提示RVA起搏对心室间及左室内收缩不协调。结论RVOT起搏心室同步性更好，对血流动力学影响较小，相比RVA起搏更为接近生理性起搏。Objective To compare the differences between fight ventricular apex （ RVA ） and right ventricular outflow tract （ RVOT ） pacing in contraction synchrony and ventricular function by using tissue Doppler imaging. Methods Forty-seven patients with atrioventricular block were implanted DDD or VVI pacemaker. They were randomized into RVA group （ n=25 ） and RVOT group （ n=22 ） .Patients were followed up for 3 and 6 months after implantationNentricular Synchrony was evaluated by QRS duration, PPEI-APEI and Ts-SD, and ventrieular function was appraised by NT-pro-BNP, LVEF and Tel index. Results Compared with pre-implantation, the QRS duration was significantly changed after ventricular pacing both in RVA pacing and RVOT pacing （ P〈0.01 ） . But the increment in RVOT pacing was less than RVA pacing （ P〈0.05 ） ; after six months, Tel index and NT-pro-BNP （ P〈0.05 ） was less in RVOT pacing than in RVA pacing.After three and six months, APE1-PPEI and Ts-sd （ P〈0.05 ） were less in RVOT pacing. Conclusion Compared with RVA pacing, RVOT pacing can provide better ventrieular synchronization and cardiac function. RVOT pacing is more physiological.

关 键 词：右室流出道起搏 心室同步性 心功能 组织多普勒 

分 类 号：R540.41[医药卫生—心血管疾病]