VDD起搏对缓慢性心律失常心力衰竭的血液动力学影响

Hemodynamic Effect of VDD Pacemaker on Congestive Heart Failure Patients With Bradycardia Arrhythmias

为了评估ＶＤＤ起搏对缓慢性心律失常心力衰竭的血液动力学影响，对２１例心功能Ⅲ～Ⅳ级的缓慢性心律失常病人安置ＶＤＤ起搏器，并用Ｓｗａｎ－Ｇａｎｚ导管监测起搏前和起搏后３０ｍｉｎ、２４ｈ、４８ｈ、７２ｈ的心输出量（ＣＯ）、心脏指数（ＣＩ）、右房压（ＲＡＰ）、平均肺动脉压（ＭＰＡＰ）和肺毛细血管楔嵌压（ＰＣＷＰ），并记录各时期的心房率（ＡＲ）和心室率（ＶＲ）。结果：ＶＲ在术后即时及各时期显著升高（Ｐ均＜０．０５），ＣＯ、ＣＩ在起搏后３０ｍｉｎ即显著升高〔分别为４．１８±０．８１Ｌ／ｍｉｎｖｓ２．８１±０．９３Ｌ／ｍｉｎ、２．３６±０．６６Ｌ／（ｍｉｎｍ２）ｖｓ１．１８±０．６３Ｌ／（ｍｉｎｍ２），Ｐ均＜０．０５〕，起搏４８ｈ达高峰；ＲＡＰ、ＭＰＡＰ、ＰＣＷＰ在起搏后３０ｍｉｎ无显著改变（Ｐ＞０．０５），但２４ｈ开始显著性下降（分别为１．２８±０．４１ｋＰａｖｓ１．４１±０．３４ｋＰａ、２．６０±０．５１ｋＰａｖｓ３．４０±０．５６ｋＰａ、３．１０±０．５６ｋＰａｖｓ３．５４±０．６８ｋＰａ，Ｐ均＜０．０５），７２ｈ后进一步降低。结果提示ＶＤＤ起搏治疗能显著改善缓慢性心律失常心力衰竭的血液动力学，可作为治疗缓慢性心?

To study hemodynamic value of VDD pacemaker on congestive heart failure (CHF) patients with bradycardia arrhythmias,21 patients with New York Heart Association functional Class Ⅲ to Ⅳ CHF were implanted VDD pacemaker for standard indications of bradycardia arrhythmias.Their hemodynamic data was measured by SwanGanz Catheter before pacemaker implantation and 30 min,24 h,48 h,72 h after pacemaker implantation.Atrial rate (AR) and ventricular rate (VR) were recorded in the same time.Results:VR was significant increased at any time after pacemaker implantation (P<0.05),Cardiac output (CO) and cardiac index(CI) were significant increased after 30 min pacing〔418±0.81 L/min vs 2.81±0.93 L/min,2.36±0.66 L/(min·m2) vs 1.18±0.63 L/(min·m2),respectively,P<005〕,and were the highest at 48 h.Right atrial pressure,mean pulmonary artery pressure,pulmonary capillary wedge pressure were not significant decreased after 30 min pacing (P>0.05).But they were significant decreased from 24 h of pacing (128±041 kPa vs 1.41±0.34 kPa,2.60±0.51 kPa vs 3.40±0.56 kPa,3.10±0.56 kPa vs 3.54±0.68 kPa,respectively,P<005) and were still decreased after 72 h pacing.The present study shows that VDD pacemaker has beneficial effect in hemodynamic of CHF patients with bradycardia arrhythmias.So VDD is an effective method for treatment of CHF patients with bradycardia arrhythmias.