右室中位间隔部起搏对左室心肌重构的影响及其与QRSd的关系  

Study on the effect of pace-making at middle right ventricular septum on left ventricular myocardial remodeling and its correlation with QRSd

作　　者：毛婉 徐健 MAO Wan;XU Jian(Anhui Medical University,Hefei 230032, China)

机构地区：[1]安徽医科大学,合肥230032 [2]阜阳市人民医院心血管内科,安徽阜阳236000 [3]安徽医科大学附属省立医院心血管内科,合肥230001

出　　处：《实用医学杂志》2019年第6期945-949,共5页The Journal of Practical Medicine

摘　　要：目的探究右室中位间隔部(RVS)起搏对左室心功能的影响,并分析心功能与QRS波群时限(QRSd)的关系。方法根据电极植入位置本院2014年1月至2016年6月将行永久性心脏起搏器植入术的123例患者分为RVS组(65例)与右室心尖部(RVA)组(58例),比较两组术后起搏参数、不同时间点心电图QRSd、左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、心脏指数(CI)及二尖瓣血流E峰/A峰最大充盈速度(E/A),Spearman相关性分析QRSd与心功能指标的关系。结果两组起搏阈值、感知阈值、导线阻抗比较差异无统计学意义(P> 0.05);与术前比较,RVA组术后3、12个月LVEF、CI、E/A均显著下降,QRSd、LVESV、LVEDV均显著上升,差异有统计学意义(P <0.05),而RVS组除了QRSd外,术后3、12个月上述指标与术前比较差异均无统计学意义(P> 0.05);RVS组术后3个月、12个月LVEF、CI、E/A均显著高于RVA组,QRSd、LVESV、LVEDV均显著低于RVA组(P <0.05);Spearman相关性分析显示QRSd与LVEF负相关,与LVESV、LVEDV均正相关(P <0.05)。结论 RVS对左室心功能及血流动力学的影响小,且QRSd与心功能相关。Objective To explore the effect of of pace making at middle right ventricular septum(RVS) pacing on left ventricular myocardial remodeling and to analyze the relationship between cardiac function and QRS duration(Q RSd). Methods 123 patients who underwent permanent pacemaker implantation in the hospital from January 2014 to June 2016 were divided into RVS group(65 cases) and right ventricular apex(R VA) group(58 cases) according to the site of electrode implantation. The postoperative pacing parameters,electrocardiogram QRSd at different time points,left ventricular ejection fraction(LVEF), left ventricular end systolic volume (LVESV), left ventricular end diastolic volume(LVEDV), cardiac index(CI) and mitral valve blood flow E peak/A peak maximum filling rate(E/A) were compared between the two groups. Spearman correlation analysis was performed to analyze the relationship between QRSd and cardiac function indexes. Results There was no sig nificant difference in pacing threshold,perceptual threshold or lead impedance between the two groups(P > 0.05). The LVEF,CI and E/A in RVA group were decreased significantly at 3 and 12 months after operation while QRSd,LVESV and LVEDV were significantly increased(P < 0.05). In RVS group,there was no significant differ ence in above indexes except QRSd at 3 and 12 months after operation,compared with those before operation(P > 0.05). The LVEF,CI and E/A of RVS group were significantly higher than those in RVA group,w hile QRSd, LVESV and LVEDV were significantly lower than those in RVA group at 3 and 12 months after operation(P < 0.05). Spearman correlation analysis showed that QRSd was negatively correlated with LVEF and positively corre lated with LVESV and LVEDV(P < 0.05). Conclusion RVS has little effects on the left ventricular function and hemodynamics,and QRSd is related to cardiac function.

关 键 词：右室中位间隔部 右室心尖部 心功能 血流动力学 QRS波群时限 

分 类 号：R541.7[医药卫生—心血管疾病]