心室不同部位起搏的急性血流动力学效应  

Comparative study of acute hemodynamic effects of multi-site cardiac pacing in patients with cardiac function NYHA class Ⅰto Ⅱ without bundle branch block

作　　者：乔万海[1] 朱参战[1] 王小闯[1] 李小珍[1] 

机构地区：[1]西安交通大学第二医院急诊科,陕西西安710004

出　　处：《中国急救医学》2003年第11期787-789,共3页Chinese Journal of Critical Care Medicine

基　　金：陕西省科委资助项目(No.2002KID-C8.29)

摘　　要：目的 在无束支阻滞、心功能Ⅰ～Ⅱ级患者中,比较5种不同起搏模式的血流动力学效应及其对QRS宽度的影响。方法 在安置永久起搏器前分别行右室心尖部、右室流出道、右室双部位、左室基底部、双室同步起搏(ⅤⅥ,60～80次/min)5min,测定心脏指数(CI)、平均肺动脉压(mPAP)、肺毛细血管嵌顿压(PCWP)以及QRS宽度。结果(1)与右室心尖部起搏相比,右室流出道、左室基底部、右室双部位、双室同步起搏CI显著增加、PCWP明显降低(P均<0.01);(2)右室双部位、双室同步起搏较右室流出道、左室基底部起搏的CI增高而PCWP降低(P均<0.05);(3)右室双部位与双室同步起搏、右室流出道与左室基底部起搏间CI和PCWP无显著差异;(4)右室流出道、右室双部位、双室同步起搏的QRS宽度较右室心尖部起搏时显著缩短(P<0.01),而左室基底部起搏与右室心尖部起搏时无显著差异。结论 在无束支阻滞、心功能Ⅰ～Ⅱ级患者中,双部位起搏的效果明显优于单部位起搏;双部位起搏的QRS宽度也比单部位起搏明显缩短。在单部位起搏中,右室流出道和左室基底部起搏优于右室心尖部起搏,但左室基底部起搏的QRS宽度无明显缩短。Objective To assess the acute hemodynamic effects of five different pacing modes in patients with cardiac function NYHA class Ⅰ to Ⅱ without bundle branch block (BBB) and to compare their effects on QRS duration. Methods This study included 12 patients (SSS 7, Ⅲ°AVB 5) undergoing pacemaker implantation. Right ventricular apex (RVA), right ventricular outflow tract (RVOT), right ventricular bifocal(RV-Bi), left ventricular base(LVB) and bi-ventricular (Bi-V) pacing at 60～80 ppm were done prior to implantation of permanent pacemaker in VVI mode. The cardiac index (CI), mean pulmonary artery pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) were measured by Swan-Ganz thermodilution catheter starting after 5 minutes of each pacing. ECG was recorded at 25 mm/ sec and 50 mm/sec simultaneously for QRS duration detection. Results ①Compared to RVA pacing(CI: 2.41±0.38 L/min per m^2, PCWP: 16.7±3.3 mmHg),the CI increased and the PCWP decreased significantly when pacing was at RVOT(CI:2.63±0.46,PCWP: 13.8±2.3), LVB(CI:2.78±0.52,PCWP: 14.4±3.1), or RV-Bi(CI:2.83±0.57, PCWP: 12.8±2.5) and Bi-V pacing (CI:2.94±0.60, PCWP 12.7±2.5), P<0.01, respectively. ②The CI of RV-Bi and Bi-V pacing were higher than that of RVOT and LVB pacing, the PCWP was lower than that of RVOY and LVB pacing, P<0.05, respectively. ③There was no significant difference between RV-Bi pacing and Bi-V pacing in CI and PCWP. ④The QRS duration of RVOT (125±10)ms, RV-Bi(110±16)ms and Bi-V pacing (111±10) ms were significantly short compared with RVA pacing (145±19)ms (P<0.01). But there was no significant difference between LVB pacing (137± 17)ms and RVA pacing. Conclusion The acute hemodynamic effects of dual site pacing were much better than that of single site pacing in patients with cardiac function NYHA class Ⅰ to Ⅱ without BBB. In addition, the QRS duration during dual s

关 键 词：多部位心脏起搏 血流动力学 QRS宽度 

分 类 号：R541.6[医药卫生—心血管疾病]