不同位点心室起搏对犬心脏作功效率影响的研究  

The Effects of Cardiac Paci ng in Different Ventricular Sites on Cardiac Work Efficiency in Dogs.

作　　者：李世强[1] 马宁[1] 傅向华[1] 苗智慧[2] 董力[2] 于占久[2] 姜云发[1] 

机构地区：[1]河北医科大学第二医院心内科,河北石家庄050000 [2]河北省医学科学院病理生理研究室,河北石家庄050021

出　　处：《中国心脏起搏与心电生理杂志》2002年第5期364-367,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：通过不同位点心室起搏 ,探讨心室激动顺序对健康犬左心室功能、冠状动脉血流量 (CBF)、心肌耗氧量(MVO2 )和心脏作功效率 (CWE)的影响。选用健康蒙古犬 1 4只 ,顺序进行His束 (HisB)、右室尖部 (RVA)、左心室侧后壁 (LVPL)单点起搏及RVA LVPL、HisB LVPL双点同步心室起搏 ,每种方式起搏持续 2 0min ,间隔 1 0min或待基本血流动力学参数恢复到最初自身窦性节律水平后 ,进行下一方式起搏 ,以各种方式的最后 3min为标准时间段测量CBF、左心室功能参数、MVO2 相关参数并计算CWE。结果 :HisB、LVPL、HisB LVPL起搏时的心排血量 (CO) ,左室内压上升最大速率 (+dp/dtmax)、下降最大速率 (-dp/dtmax)以及CBF和CWE均明显优于RVA起搏 ,CO、+dp/dtmax、-dp/dtmax、CBF和CWE在HisB、LVPL和HisB LVPL起搏间比较无差异 ;RVA LVPL起搏较RVA起搏时CBF提高 30 % (P <0 .0 5) ,而CO、+dp/dtmax、-dp/dtmax和CWE也有提高趋势 ,但无统计学差异 ;MVO2 在此 5种心室起搏方式间无差异 ;HisB、HisB LVPL起搏较RVA LVPL起搏时CWE分别提高 1 7%和 1 4 % (P <0 .0 5)。结论 :对于健康犬心脏急性实验而言 ,在起搏介入条件下 ,保持正常的心室激动顺序和同步性有利于改善CBF ,提高左心室的收缩和舒张功能 ,改善CWE。The aim of this investigation was to assess the effects of cardiac pacin g with different ventricular activation sequences on left ventricular function,c oronary blood flow (CBF),myocardial oxygen consumption (MVO 2),and cardiac wo rk efficiency (CWE).Five kinds of ventricular pacing mode including right ventri cular apical pacing (RVA),His Bundle pacing (HisB),left ventricular posterior la teral wall pacing (LVPL),right ventricular apex-left ventricular posterior late ral wall synchronous pacing (RVA-LVPL) and His Bundle-left ventricular posteri or lateral wall synchronous pacing (HisB-LVPL) were performed in 14 healthy adu lt mongrel dogs in randomized orders.Every pacing mode was to capture sinus rhyt hm for 20 min with a 10 min rest period between each of the modes or more after the basic hemodynamic parameters recovering to baseline conditions of original s inus rhythm.All parameters were measured simultaneously during the last 3 minute s before each pacing mode as well as sinus rhythm ended.Results:Cardiac output ( CO),The maximum positive and negative rate of pressure development (+ dp/dt ma x,- dp/dt max),CBF and CWE during HisB,LVPL and HisB-LVPL all increased signi ficantly compared to those during RVA.These parameters indicated no significant difference during HisB,LVPL,and HisB-LVPL compared with one another.CBF enhance d 30%( P <0.05) during RVA-LVPL than that during RVA,while CO,+ dp/dt max,- dp/dt max,and CWE tended to increment but P >0.05.MVO 2 during all modes of cardiac pacing showed no statistical significance compared with one another.C WE increased 17% and 14%( P <0.05) during HisB and HisB-LVPL compared with th at during RVA-LVPL respectively.Conclusion:Based on the short-term study in he althy dogs with cardiac pacing,these data demonstrated that it was a vital thing to normalize ventricular activation synchrony that were beneficial to improve C BF,left ventricular systolic and diastolic function,and CWE.

关 键 词：心血管病学 心脏起搏 心脏作功效率 冠状动脉血流量 心肌耗氧量 左心室功能 

分 类 号：R541.4[医药卫生—心血管疾病]