主动电极右心室间隔部起搏患者心肌损伤电流和起搏参数变化  

Changes of injury current and pacing parameters in patients before and after pacemaker implantation of active electrodes at right ventricular septum

作　　者：艾民[1] 颜昌福[1] 贺剑[1] 夏福纯[1] 江军[1] AI Min;YAN Changfu;HE Jian;XIA Fuchun;JIANG Jun(Pangang General Hospital of Kunming University of Science and Technology,Panzhihua 617023,China)

机构地区：[1]昆明理工大学附属攀钢集团总医院,四川攀枝花617023

出　　处：《山东医药》2018年第40期6-9,共4页Shandong Medical Journal

基　　金：四川省医学科研课题(S17045)

摘　　要：目的观察主动电极右心室间隔部(RVS)起搏患者心肌损伤电流(COI)、起搏阈值、R波感知和电极阻抗的变化。方法 93例接受心脏起搏器植入治疗患者,根据起搏电极植入的类型和部位,将患者分为主动电极RVS起搏组(ZDRVS组) 56例、被动电极右心室心尖部起搏组(BDRVA组) 37例。临床随访1年,比较两组患者电极植入时间,手术总时间,QRS波时限,电极固定即刻、5 min、10 min的COI,术中及术后1周、1月、3月、6月、12月的起搏阈值、R波感知和电极阻抗。结果 ZDRVS组术后QRS波时限短于BDRVA组(P <0. 05)。ZDRVS组电极固定即刻、5 min、10 min的COI均高于BDRVA组(P均<0. 05)。ZDRVS组术后1周、1月、3月、6月、12月起搏阈值均低于BDRVA组(P均<0. 05),ZDRVS组术中及术后1周、1月、3月、6月、12月电极阻抗均低于BDRVA组(P均<0. 05),两组R波感知比较差异均无统计学意义(P均> 0. 05)。结论主动电极RVS起搏植入术患者术中COI高,术后QRS波时限短、起搏阈值低、电极阻抗小,临床随访起搏参数保持相对稳定。Objective To explore the current of injury(COI),pacing threshold,R wave perception threshold and electrode impedance in the right ventricular septum(RVS)pacing of active electrode and the right ventricular apex(RVA)pacing of passive electrode.Methods We divided 93 patients who received pacemaker implantation into the right ventricular septum pacing of active electrode group(ZDRVS group,56 cases)and the right ventricular apex pacing of passive electrode(BDRVA group,37 cases).All patients were followed up for one year.We evaluated the electrode implantation time,total operative time,QRS wave time,immediate current of injury(COI0 min),5-minute current of injury(COI5 min),10-minute current of injury(COI10 min),pacing threshold,R wave perception threshold,and electrode impedance in the patients of two groups.Results The electrode implantation time of ZDRVS group was longer than that of BDRVA group(P<0.05).There was no significant difference in the operation total time between two groups(P>0.05).After operation,the QRS wave time was shorter in the ZDRVS group than in the BDRVA group(P<0.05).COI0 min immediately reached the peak in patients of two groups after the electrode fixation,and then decreased.COI0 min,COI5 min and COI10 min of the ZDRVS group were higher than those in the BDRVA group(all P<0.05).The pacing threshold of postoperative in the ZDRVS group was lower than that in the BDRVA group(P<0.05).During and after the operation,the electrode impedance of the ZDRVS group was lower than that of the BDRVA group(P<0.05).There was no significant difference in the R wave perception threshold between the two groups(P>0.05).Conclusion As for patients after active electrode RVS pacing implantation,their COI increases with shorter postoperative QRS wave time,low pacing threshold,and decreased electrode impedance,while their pacing parameters are relatively stable in clinical follow-up.

关 键 词：主动电极右心室间隔部起搏植入术 心脏起搏 主动电极 被动电极 心肌损伤 损伤电流 起搏参数 

分 类 号：R654.2[医药卫生—外科学]