右心室不同部位起搏血液动力学改变的研究  

HEMODYNAMIC CHANGES OF RIGHT VENTRICULAR DIFFERENT-SITE PACEING

作　　者：柳茵[1] 樊世明[1] 刘维军[1] 李琳[1] 于伊[1] 梅峰[1] 刘连军[1] 

机构地区：[1]青海医学院附属医院心内科,810001

出　　处：《青海医药杂志》2003年第12期2-6,共5页Qinghai Medical Journal

摘　　要：目的 :根据右心室不同部位起搏时血液动力学改变 ,研究选择置入右心室双部位起搏器辅助治疗心脏扩大合并充血性心力衰竭 (CHF) ,观察临床效果及心脏功能 ;方法 :对1 3例在心内科住院的扩张型心肌病、缺血性心肌病、心动过速性心肌病所致心力衰竭的患者 ,男 9例 ,女 4例 ,年龄 3 6岁～ 75岁 (平均 58.61岁 ) ,心功能均在Ⅲ级～Ⅳ级 (NYHA) ,均有置入起搏器的适应证。术中通过Swan -ganz漂浮导管对右心室内不同部位起搏 1 0分钟后测各部位的急性血液动力学改变 ,然后置入右心室双部位起搏器 (右室流出道应用主动固定电极 )。术后应用心电图、超声心动图观察右心室双部位起搏的血液动力学效果 ;结果 :全组 1 3例患者术中检查及置入右心室双部位起搏器均获成功。测得右心室流出道起搏(RVOT)和右室心尖部 (RVA) +右室流出道 (RVOT)起搏时各参数均较单纯右室心尖部(RVA)为好。置入心脏起搏器后观察射血分数从 0 .3 1提高至 0 .3 9,左室充盈时间延长 ,二尖瓣返流量减少 ,心脏缩小 ,心脏功能平均提高Ⅱ级。其中一例心功能由Ⅳ级提高至Ⅰ级～Ⅱ级 ;结论 :初步血液动力学观察提示 ,右心室双部位起搏能改善充血性心力衰竭患者的心功能。Objective:According to the hemodynamic change of right ventricular different-site pacing, we researched into right ventricular pacemaker, which used to auxiliary treatment in cardiac dilatation combined with congestive heart failure, then observed clinical effect and heart function.Methods: 13 patients with congestive heart failure caused by dilated cardiomyopathy 、 ischemic 、cardiomyopathy and tachycardiac cardiomyopathy. We measured acute hemodynamic change after 10 minutes operation using the swan-ganz floating catheter then placed right ventricular bifocal pacemaker and observed hemodynamic effect of the right ventricular bifocal pacing.Result: All cases got success in terms of examination in the course of operation and postoperation. Cardiac ejection fraction was increased from 0.31 to 0.39(P<0.05), mitral reflux dropped, cardiac volume shrank and heart function upgraded Ⅱequally.Conclusion: The results suggest that right ventricular bifocal pacing can improve heart function of patients with congestive heart failure.

关 键 词：右心室双部位起搏器 心脏扩大 充血性心力衰竭 血液动力学 心功能 

分 类 号：R654.2[医药卫生—外科学]