超速起搏对动脉压力影响的临床研究

Clinical study on changes of mean arterial pressure through overdrive pacing

目的探讨心室超速起搏对动脉压力的影响,以明确其在主动脉腔内隔离术中的应用价值。方法对30例左侧旁路射频消融术后患者,以180～220次/min的频率行心室超速起搏,使外周平均动脉压下降至60 mmHg(1 mmHg=0.133 kPa),通过有创动脉压力持续同步监测血压并记录压力图形的变化,观察心室超速起搏前后血压下降的速度和幅度及血压降至目标血压所需时间,停止起搏后血压恢复至基础血压的速度和幅度及所需时间;观察患者在超速起搏术中及术后3个月有无心、脑、肾等器官的不良事件。结果入选的30例患者顺利完成心室程序刺激。心室超速起搏(3.1±1.6)心搏后外周动脉平均动脉压从91.3 mmHg下降至37.8 mmHg,目标平均动脉压达标需(858.7±361.7)ms。停止起搏后(1.9±0.6)心搏后平均动脉压恢复至基础水平,约需(1 042.2±174.0)ms。术中、术后3个月随访患者无心、脑、肾等脏器的不良事件。结论心室超速起搏可以迅速、安全、有效地控制平均动脉压,可作为主动脉覆膜支架释放时较佳的血压控制手段。

Objective Studying the changes of mean arterial pressure through overdrive right ventricular pacing to investigate the safety and efficacy of overdrive pacing during thoracic stent-graft placement.Methods A prospective protocol was conducted of 30 patients with left path way who had undergone intracardiac electrophysiologic studies.Rapid right ventricular pacing was initiated at the rate of 180220 beats per minute,the time of mean arterial pressure reduced to 60 mmHg and the time of the mean arterial pressure returned to baseline after cessation of pacing were observed.And side effects in the patients during the rapid pacing and three months＇ follow-up after the operation were observed.Results A mean of（3.1±1.6） bursts（858.7±361.7） ms pacing sequences at rate of 180220 beats per minute were used to make the mean arterial pressure reduce to 60 mmHg,and（1.9±0.6） bursts（1 042.2±174.0） ms after cessation of pacing the mean arterial pressure returned to baseline.There were no side effects in the patients during the rapid pacing and three months＇ follow-up after the operation.Conclusion Overdrive pacing appears to be an effective and safe procedure to reduce the mean arterial pressure,and is a relatively reliable technique to facilitate precise endovascular stent-grafts deployment in the thoracic aortic dissection.