犬双心室多点组合同步起搏的心肌力学效应研究  

THE EFFECTS OF CARDIAC PACING WITH MULTISITE COMDINATION ON MYOCARDIAL MECHANICS AND CARDIAC WORK IN DOGS

作　　者：马宁[1] 傅向华[1] 李世强[1] 吴伟力[1] 谷新顺[1] 姜云发[1] 

机构地区：[1]河北医科大学第二医院,河北石家庄050000

出　　处：《中国应用生理学杂志》2003年第4期354-358,共5页Chinese Journal of Applied Physiology

基　　金：河北省自然科学基金资助项目 ( 3972 6 1 )

摘　　要：目的 :探讨多点组合同步心室起搏对犬心肌收缩 /舒张力学效应和心脏作功的影响。方法 :12只犬 ,随机进行 5种组合模式的双心室同步起搏 ,并以自身窦性心律状态 (SNR )作为对照。记录各起搏状态下 :左室内压上升和下降最大数率 (±dp/dtmax)、左室松弛时间常数 (τ)、左 /右室游离壁室壁肌张力 (L/RV tensileforce ,L/RV TF)、每搏量 (SV )、左室每搏功 (LVSW )和右室每搏功 (RVSW )等心肌收缩 /舒张力学和心脏作功参数。结果 :双室cHisB LVPL起搏和RVA LVPL起搏的心肌收缩力学参数 +dp/dtmax和L/RV TF较右室双点cHisB RVA起搏增加 ,前两组的心肌舒张力学参数 dp/dtmax也较cHisB RVA起搏增加 ,而τ值较后者缩短。双室三点cHisB RVA LVPL起搏和cHisB RVA LVA起搏的上述各参数均优于双室cHisB LVPL起搏和RVA LVPL起搏。而cHisB RVA LVPL起搏的 +dp/dtmax和L/RV TF均较cHisB RVA LVA起搏增加。cHisB RVA LVPL起搏 dp/dtmax较cHisB RVA LVA起搏提高 6.0 % ,τ值缩短 3 .7%。cHisB LVPL起搏和RVA LVPL起搏的SV、LVSW和RVSW等心室作功参数均较cHisB RVA起搏增加 ,而HisB RVA LVPL起搏的上述心脏作功各参数 ,亦分别较cHisB RVA LVA起搏和cHisB LVPL起搏有不同程度的增加。结论 :双室三点cHisB RVA LVPL组合同?Aim: To approach the effects of multi-site synchronous ventricular paci ng on myocardial mechanics and cardiac work. Methods: Five modes of multi-site synchronous ventricular pacing were randomly performed in 12 dog s with anesthetized, opened chest and artificial-ventilation. Some parameters w ere measured simultaneously including: the peak of left ventricular pressure ris e and fall (±dp/dt max ), the time constant of left ventricular relaxation( τ), the muscle tensile force in left/right ventricular wall (V-tensile force,V -TF), SV, LVSW and RVSW. Results: The myocardial systolic mech anical parameters: +dp/dt max and LV-TF of cHisB-LVPL and RVA-LVP L pacing by biventricular pacing modes were increased than that of cHisB-RVA pa cing in right ventricular bifocal pacing mode. +dp/dt max in above t wo groups of biventricular pacing was increased than that in cHisB-RVA pacing. τ value of cHisB-LVPL and RVA-LVPL pacing modes were shorted than that of cHi sB-RVA pacing. The above parameters of cHisB-RVA-LVPL and cHisB-RVA-LVA biv entricular trifocal pacing were superior to that of cHisB-LVPL and RVA-LVPL bi ventricular pacing. The +dp/dt max , LV-TF and RV-TF of cHisB-RVA -LVPL pacing were increased as compared with that of cHisB-RVA-LVA pacing ( P>0.05). The -dp/dt max in cHisB-RVA-LVPL pacing were increased by 6.0% and τ value was shorted by 3.7% compared with those in cHisB-RVA-LVA pacing(P>0.05). SV, LVSW and RVSW of cHisB-LVPL and RVA-LVPL biventricula r pacing were increased than those of cHisB-RVA bifocal pacing. The above param eters of cHisB-RVA-LVPL pacing were increased than that of cHisB-RVA-LVA and cHisB-LVPL pacing. Conclusion: It was explained that the cHisB -RVA-LVPL biventricular trifocal sites synchronous pacing mode would increase the velocity of ejection and filling during myocardial contraction and relaxatio n and enhance cardiac work by maintaining normal VSS.

关 键 词：心脏起搏 心脏作功 心肌力学 犬 

分 类 号：R318.11[医药卫生—生物医学工程]