右室单双部位起搏对心功能和QRS宽度的影响  

The effects of right ventricular bifocal pacing on cardiac function and QRS duration

作　　者：朱参战[1] 张全发[1] 崔长琮[1] 薛小临[1] 傅文[1] 刘维维[1] 刘引会[1] 徐琳[1] 

机构地区：[1]西安交通大学第一医院心内科,陕西西安710061

出　　处：《心脏杂志》2003年第1期25-27,共3页Chinese Heart Journal

摘　　要：目的 :比较右室双部位 (RV- Bi)起搏与右室心尖部 (RVA )、右室流出道 (RVOT)起搏对心功能的影响及 RQS宽度的变化。方法 :患者 15 (男 10 ,女 5 )例 ,年龄 66± 6岁 ,其中病态窦房结综合征 (SSS) 8例 ,三度房室阻滞 ( °AVB) 7例。分别行 RVA,RVOT,RV- Bi起搏 (VVI,60～ 90· min- 1 ,测定心排出量 (CO)和心脏指数 (CI)、平均肺动脉压 (m PAP)和肺毛细血管嵌顿压 (RCWP) ,QRS宽度 (QRSd)和电轴 (QRSa)。结果 :1与 RVA起搏 (CO:4.16±0 .5 1L/ min;CI:2 .3 9± 0 .3 4L· min- 1 · m- 2 ;PCWP:17.5± 3 .7mm Hg)相比 ,RVOT起搏 (CO:4.42± 0 .63 L/min;CI:2 .5 7± 0 .45 L· min- 1· m- 2 ;PCWP:14.9± 3 .7m m Hg)和 RV- Bi起搏 (CO:4.77± 0 .69L/ min;CI:2 .76± 0 .5 3 L· m in- 1 · m- 2 ;PCWP:13 .7± 3 .1mm Hg) CO,CI显著增加、PCWP明显降低 (P<0 .0 5～ 0 .0 1) ;2 RV - Bi起搏较 RVOT起搏的 CO,CI增高 (P<0 .0 1)而 PCWP降低 (P<0 .0 5 ) ;3 RVOT,RV- Bi起搏的 QRSd(分别为12 8± 11ms;111± 16m s)较 RVA起搏时 (146± 18m s)显著缩短 (P<0 .0 5～ 0 .0 1) ;RV - Bi起搏又比 RVOT起搏明显缩短 (P<0 .0 1)。结论 :右室双部位 (RV- Bi)起搏的心功能明显优于 RVA,RVOT等单部位起搏 ;AIM:To assess the potential value of right ventricular bifocal(RV Bi) pacing. METHODS:15 pts(66±6 a,10 men;8 SSS,7Ⅲ°AVB)underwent pacemaker implantation,right ventricular apex(RVA),outflowtract(RVOT) and RV Bi pacing at rate 60~90 ·min -1 in VVI mode prior to permanent pacemaker implantation. The CO,CI,mPAP and PCWP were measured by Swan Ganz thermodilution catheter 5 min after each pacing. ECG was recorded at 25 mm/s and 50 mm/s simultaneously for QRS duration (QRSd). ESULTS:Compared with RVA pacing(CO:4.16±0.51 L/min;CI:2.39±0.34 L·min -1 ·m -2 ;PCWP:17.5±3.7 mm Hg),the CO and CI increase and the PCWP decreases significantly during RVOT pacing(CO:4.42±0.63 L/min;CI:2.57±0.45 L·min -1 ·m -2 ;PCWP:14.9±3.7 mm Hg) and RV Bi(CO:4.77±0.69 L/min;CI:2.76±0.53 L·min -1 ·m -2 ;PCWP:13.7±3.1 mm Hg), P <0.05~0.01. ②The CO and CI of RV Bi pacing were higher than those of RVOT pacing( P <0.01),the PCWP was lower than that of RVOT pacing ( P <0.05).③The QRSds of RVOT(128±11 ms) and RV Bi pacings(111±16 ms) were significant shortened compared with that of RVA pacing (146±18 ms), P <0.05~0.01,and the QRSd of RV Bi pacing was the shortest. CONCLUSION:The cardiac function of RV Bi pacing was much better than those of RVA and RVOT pacings. The QRSd during RV Bi pacing was significantly shorter than those of RVA and RVOT pacings.

关 键 词：扩张型心肌病 右室单双部位起搏 心功能 QRS宽度 

分 类 号：R542.2[医药卫生—心血管疾病]