右心室流出道间隔部起搏的可行性及有效性分析  

Feasibility and Effectiveness of Right Ventricular Outflow Tract Septum Pacing

作　　者：汪杰[1] 张斌[1] 赵永燕[1] 熊恩来[1] 刘玥[2] Wang Jie Zhang Bin Zhao Yongyan et al(Cardiology department, The People＇s Hospital of Tonling, Anhui 244000, Chin)

机构地区：[1]安徽省铜陵市人民医院心血管内科,244000 [2]中国中医科学院西苑医院心血管病中心,北京100091

出　　处：《医学研究杂志》2017年第7期44-47,共4页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81403266)

摘　　要：目的比较右心室流出道间隔部起搏(right ventricular outflow tract septum,RVOTS)与右心室心尖部起搏(right ventricular apical RVA)的手术过程、起搏参数及对心功能的影响,探讨右心室间隔部起搏的可行性及有效性。方法符合永久起搏器置入指征的房室传导阻滞患者66例行右心室间隔部起搏及右心室心尖部起搏,各33例,测定手术时间、X线曝光时间及起搏QRS波宽度,于术后3个月及6个月进行随访,测定起搏参数(阈值、感知、阻抗)、心房脑钠钛(BNP)水平、及6min步行试验距离。结果 33例右心室流出道间隔部起搏完成32例,并发症与心尖部起搏无差异;右心室流出道间隔部起搏手术时间、X线曝光时间长于心尖部起搏,起搏QRS波宽度时限短于心尖部起搏;右心室流出道间隔部起搏电极置入即刻阈值高于心尖部起搏,其余时间两组起搏阈值、感知及阻抗均无差异;术后3、6个月,两组患者BNP水平均高于术前,右心室流出道间隔部起搏BNP水平低于心尖部起搏;术后6个月BNP水平与QRS波宽度呈正相关。结论右心室流出道间隔部手术可行,能够有效改善心室电机械同步性及心功能,值得基层推广应用。Objective To observe the effects of right ventricular outflow tract septum （RVOTS） pacing or right ventricular apical （RVA） pacing on surgery procedures, pacing parameter and the influence to cardiac function and investigate the feasibility and effective- ness of RVOTS pacing. Methods Sixty six patients who had atrioventricular block were randomly divided into two groups （ Group RVOTS and Group RVA, each group had 33 patients） were implanted pacemakers. ALL patients were followed up at three- , six -month. The time of operation and X - ray exposure, QRS duration, pacing parameters, BNP level and the distance of six minutes walking were ana- lyzed. Results Thirty two patients in Group RVOTS were successfully completed surgery and the complication had no difference between RVOTS and RVA pacing. The time of operation and X - ray exposure in Group ROVTS were longer than Group RVA, the QRS duration was longer in Group RVA. Pacing threshold during implanting in Group RVOTS was higher than Group RVA, but the other pacing param- eters had no different. At three - , six - month after operation, the BNP levels were both higher than pre - operation in two groups, the BNP level in Group ROVTS were lower than Group RVA. At six - month after operation, the BNP level had correlation with QRS duration. Conclusion Right ventricular outflow tract septum pacing is feasible, which can improve ventricular synchronization and cardiac function, so the method is worth generalizing and applying in primary hospital.

关 键 词：右心室流出道间隔部 起搏 心功能 B型钠尿肽 

分 类 号：R4[医药卫生—临床医学]