术中选择最佳心室起搏部位的临床研究

Study on selection of optimal cardiac ventricular pacing position in operation

目的探讨右心室各部位起搏对急刻的心电生理学和血流动力学影响,便于术中选择最佳心室电极植入部位。方法对52例有起搏器植入适应症的患者,采用无创胸电生物阻抗法连续血液动力学监护系统在术中比较不同起搏部位的心输出量(CO)、每搏输出量(SV)、心脏指数(CI)、心脏功能的加速度指数(ACI)、预射血时间(PEP)、左心室射血时间(LVET),同时抗进行测试比较起搏阈值、R波幅度、电极阻抗和各部位起搏前后QRS时限,选择对血流动力学影响小的部位置入永久性起搏器电极。结果右心室心尖部与右心室间隔及右心室流出道起搏阈值、R波幅度、电极导线阻抗比较差异无统计学意义(P>0.05);右心室心尖部起搏时QRS时限长;其心输出量(CO)、每搏输出量(SV)、心脏指数(CI)和心脏功能的加速度指数(ACI)均比右心室间隔及右心室流出道起搏时低,而预射血时间(PEP)长、左心室射血时间(LVET)缩短、PEP/LVET比值大。右心室心尖部起搏时对心脏功能影响大(P<0.05),右心室间隔及右心室流出道起搏时QRS时限与血流动力学改变差异无统计学意义(P>0.05)。结论右心室间隔及右心室流出道起搏比心尖部起搏具有更好的血流动力学效应。

Objective To investigate the influence of different earatiac right ventricular pacing positions on cardiac electrophysiology and hemodynamics. Methods During the operation,52 patients with indication for permanent VVI were tested pacing threshold, amplitude of R wave, electrode cahleimpedanee, cardiac output, stroke volume, cardiac index, acceleration of cardiac function index,ejection prophase and left ventricular ejection by Biozcom. Several pacing places were tested and compared before the optimal place was identified. Results There were no significant differences in pacing threshold,amplitude of wave R, electrode cable impedance among right ventricle apex,right ventricular outflow tract and right ventricular septum（P〉0.05）. The QRS duration,cardiac output, stroke volume, cardiac index, acceleration of cardiac function index, ejection prophase and left ventricular ejection time had significant differences between right ventricle apex and right ventricular outflow tract, right ventricular septum （P〈0.05）. There were no significant differences between right ventricular outflow tract and right ventricular septum（P〉0.05）. Conclusion Cardiac electrophysiology and hemodynamics of the permanent pacing position at right ventricular outflow tracter right ventricular septum are more bereficially than the pacing position of right ventricle apex.