右室流出道间隔部起搏的血流动力学观测

Effects of pacing on hemodynamics in right ventricular outflow tract

目的比较右室流出道间隔部(RVS)与右室心尖部(RVA)起搏对血流动力学的影响。方法选择具备起搏器植入指征的患者30例,随机分为RVA组与RVS组,采用超声心动图检测左室射血分数(LVEF)、每搏量(SV)、左室短轴缩短率(FS)、心脏指数(CI),对比观察术前、术后3,6个月差异。并比较术前与术后心电图QRS波宽度。结果两组患者均顺利完成手术。两组QRS波时限均较自身心律时延长,差异有统计学意义(P<0.01),RVA组起搏QRS时限显著长于RVS组[(158±15)msvs(132±15)ms,P<0.01];RVA组术后3个月随访LVEF,SV,FS,CI较术前均显著降低,均有统计学意义[(59±3)%vs(51±3)%,(79±15)mlvs(71±16)ml,(0.36±0.11)vs(0.31±0.09),(2.5±0.4)L/(min·m2)vs(2.1±0.4)L/(min.m2),均P<0.05];RVS组术后3,6个月随访LVEF,SV,FS,CI与术前无显著性差异,RVS组3,6个月随访LVEF,SV,FS,CI均显著高于同期RVA组,均有统计学意义(均P<0.05)。结论RVS起搏尽可能的保证了心室激动和收缩同步性,实现了比RVA起搏较为良好的血流动力学状态。

AIM To compare the effects of pacing on hemodynamics in right ventricular septum and in right ventricular apex. METHODS Thirty patients performed with DDD or VVI pacing were grouped randomly into two groups, 15 patients in one group received RVS pacing, while 15 patients in the other group received RVA pacing. The QRS waves of the ECG of the preoperation and the postoperation were recorded and analyzed. The hemodynamie parameters of LVEF, SV, FS and CI were compared between preoperation, 3 months and 6 months after operation by echocardiography. RESULTS The QRS duration in RVA group was longer than that in RVS group significantly [ （ 158 ± 15） vs （ 132 ± 15） ms, P 〈 0. 01 ]. Compared with RVA pacing, RVS pacing better improved LVEF, SV, FS and CI [ （58 ± 4） vs （51±3）%, （77 ±15） vs （71 ±16） ml, （0.37 ±0.10） vs （0.31 ±0.09）, （2.5 ±0.4） vs （2.1± 0. 4） L/（ min · m^2） , P 〈 0.05 ] three months after implantment of pacemakers. The LVEF, SV, FS and CI of RVA group 3 months after operation decreased significantly [ （59 ± 3 ） % vs （51 ± 3 ） %, （79 ± 15） ml vs （71 ± 16） ml, （0. 36 ±0. 11） vs （0. 31 ±0. 09）, （2.5 ±0. 4） L/（min·m^2） vs （2. 1 ±0. 4） L/（min ·m^2）, P 〈 0. 05）]. CONCLUSION Compared with RVA pacing, RVS pacing presents a more physiological depolarization pattern and better hemodynamics.