超声心动图指导双腔起搏器房室间期的评价研究

Preliminary study on echocardiographic guidance atrioventricular interval of patients with dual-chamber pacemaker

目的:探讨超声心动图在双腔起搏器患者术后左心功能评价中的价值。方法:选取60例行双腔起搏器植入术的患者,采用随机数表法将其平均分为观察组及对照组,每组30例。观察组患者进行超声心动图指导优化房室间期,对照组患者进行经验性程控房室间期,分别于术前、术后3个月和6个月时对两组患者行超声心动图检查,对比观察患者二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A)、E峰减速时间(DT)、二尖瓣环舒张早期峰值流速(Em)、等容舒张时间(IVRT)、左房容积指数(LAVI)、心功能分级(NYHA)、6 min步行距离实验(6MWT)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、主动脉瓣口速度时间积分(VTI)、脑钠肽前体水平(Pro-BNP)、心输出量(CO)、心脏指数(CI)、A/E比值以及心脏每搏量等指标。结果:术后6个月时,观察组患者LVEF、VTI、6MWT以及Pro-BNP等指标较对照组患者改善明显,两组比较差异有统计学意义(t=2.683,t=3.832,t=4.168,t=3.479;P<0.05),VP、LVEDD及NYHA grading等指标无明显差异(t=0.813,t=1.832,t=1.034,P>0.05);术后观察组患者HR、CO两项指标较对照组改善明显,差异有统计学意义(t=4.328,t=3.132,P<0.05),其余SV、CI及A/E等指标无明显差异。结论:超声心动图检查无创伤,且操作简便,可有效对双腔起搏器植入患者左心功能进行评价,值得在临床中推广使用。

Objective： To evaluate the value of echocardiography in FIG dual chamber pacemaker patients in left ventricular function assessment. Methods： From January 2014 to January 2016 in our hospital, 60 cases with dual chamber pacemaker implantation were randomly divided into observation group and control group, each with 30 cases. The observation group were treated with echocardiographic guidance optimized atrioventricular interval, and the control group with empirical programmed AV interval, respectively. We check their echocardiography before surgery and 3 months and 6 months after surgery. And we comparatively observed their mitral early diastolic flow velocity（E）, late diastolic velocity（A）, E wave deceleration time（DT）, peak early diastolic mitral annular velocity（Em）, isovolumic relaxation time（IVRT）, left atrial volume index（LAVI）, NYHA functional class（NYHA）, 6-minute walk test（6MWT）, left ventricular ejection fraction（LVEF）, left ventricular end-diastolic diameter（LVEDD）, aortic valve velocity time integral（VTI）, brain natriuretic peptide levels（Pro-BNP）, cardiac output（CO）, cardiac index（CI）, A / E ratio and cardiac stroke volume and other indicators. Results： After 6 months, LVEF, VTI, 6MWT and Pro-BNP and other indicators in the observation group improved significantly than that in the control group. The difference were statistically significant（t=2.683, t=3.832, t=4.168, t=3.479; P〈0.05）. VP, LVEDD and NYHA grading and other indicators were no significant different（t=0.813, t=1.832, t=1.034; P〉0.05）. Two indicators of HR and CO in the observation group improved significantly than that in the control group（t=4.328, t=3.132; P〈0.05）. The other indicators including SV, CI and A/E were no significant different. Conclusion： Echocardiography is non-invasive and easy to operate. It can be effective for a dual chamber pacemaker implantation in patients with left ventricular function, and it is worth popularizing in clinical application.