超声心输出量监测仪用于指导房室传导阻滞患者起搏器房室间期优化的随机对照研究  

Ultrasound cardiac output monitor versus conventional method for guiding pacemaker atrioventricular interval optimization in patients with atrioventricular block:a randomized controlled study

作　　者：王双玲 杨倩 李国春 蔡可欣 郭涛 郭雨龙 Wang Shuangling;Yang Qian;Li Guochun;Cai Kexin;Guo Tao;Guo Yulong(Graduate School of Kunming Medical University,Kunming 650500,China;Department of Arrhythmia,Fuwai Yunnan Cardiovascular Hospital,Chinese Academy of Medical Sciences,Kunming 650102,China;Department of Cardiology,Guiyang Second Peoples Hospital,Guiyang 550000,China)

机构地区：[1]昆明医科大学研究生院,650500 [2]云南省阜外心血管病医院心律失常中心,昆明650102 [3]贵阳市第二人民医院心内科,550000

出　　处：《中国心血管杂志》2024年第6期540-546,共7页Chinese Journal of Cardiovascular Medicine

基　　金：云南省科技厅科技计划项目-昆医联合专项(202301AY070001-043);云南省卫生健康委临床医学中心建设项目(FZX2019-06-01);云南省阜外心血管病医院院级科研基金项目(2019YFKT-04);云南省临床医学研究中心项目(202102AA310002)。

摘　　要：目的评估超声心输出量监测仪(USCOM)在指导房室传导阻滞(AVB)患者起搏器房室间期(AVI)优化的效果。方法随机对照试验。纳入2021年11月至2023年12月在云南省阜外心血管病医院就诊的二度Ⅱ型及以上AVB且植入永久双腔起搏器患者95例,按照随机数生成器软件自动生成的单双数字将患者随机分为USCOM程控AVI优化组(双数,USCOM组,56例)和常规经验性程控组(单数,常规组,39例)。使用USCOM测量患者心排血量(CO)、心脏指数(CI)、速度时间积分(VTI)、每搏输出量(SV)、外周血管阻力(SVR)及外周血管阻力指数(SVRI)。通过经胸超声心动图检查在AVI优化前及优化后1个月对两组患者心脏结构和功能进行评估。结果在AVI优化后,即刻测量USCOM组血流动力学指标,USCOM组CO、CI、VTI和SV高于常规组(Z=-4.194、-3.679、-3.618和-4.548,均为P<0.001),而SVR和SVRI低于常规组(Z=-3.363和-2.587,均为P<0.05)。患者在AVI优化后1个月再次复查超声心动图,常规组二尖瓣口舒张晚期血流速度高于USCOM组,差异有统计学意义(t=2.757,P=0.007)。以USCOM指导优化的最佳SAV/PAV在90/120 ms至300/330 ms之间,离散度较大,主要集中于180/210 ms(18例)。结论通过USCOM指导AVB患者双腔起搏器AVI优化是一种安全、可行且有效的新方法,值得临床推广。Objective To evaluate the effectiveness and feasibility of ultrasound cardiac output monitoring(USCOM)in guiding atrioventricular interval(AVI)optimization in patients implanted pacemakers for atrioventricular block(AVB).Methods We conducted a randomized controlled study.A total of 95 patients with severe AVB and implanted with permanent dual-chamber pacemakers in Fuwai Yunnan Cardiovascular Hospital from November 2021 to December 2023 were included,and randomly divided into the USCOM-guided group(56 cases)and the conventional group(39 cases).Cardiac output(CO),cardiac index(CI),velocity time integral(VTI),stroke volume(SV),peripheral vascular resistance(SVR),and peripheral vascular resistance index(SVRI)were measured by USCOM in all enrollers and compared between two groups.Cardiac echocardiography parameters before AVI optimization and one month later were collected and compared between the two groups,including left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD).Results Compared to the conventional group,the USCOM-guided group had higher CO,CI,VTI and SV(Z=-4.194,-3.679,-3.618,and-4.548,respectively,all P<0.001)and lower SVR and SVRI(Z=-3.363 and-2.587,respectively,both P<0.05).The peak mitral late-diastolic inflow velocity was higher in the convetional group than in the USCOM-guided group.The optimal SAV/PAV in USCOM-guided group ranged from 90/120 ms to 300/330 ms.Most were at 180/210 ms(18 patients).Conclusions The USCOM-guided optimization for pacemaker AVI is safe,feasible,and effective,and improves short-term hemodynamics in AVB patients.

关 键 词：房室传导阻滞 心脏起搏器 人工 血流动力学 房室间期 超声心输出量监测仪 

分 类 号：R541.7[医药卫生—心血管疾病] R445.1[医药卫生—内科学]