右心室间隔部与右心室心尖部起搏对心脏血流动力学的影响

Effects on Hemodynamics by Pacing in Right Ventricle Septum and Right Ventricle Apex

目的探讨右心室间隔部(RVS)起搏和右心室心尖部(RVA)起搏对患者急性期及慢性期血流动力学的影响。方法将80例3度或高度房室传导阻滞患者随机分为两组(各40例),RVS组行RVS起搏,RVA组行RVA起搏。观察两组患者术中情况,监测术中血流动力学变化,比较两组术后随访起搏器心室起搏率、心电图QRS波宽度、心脏功能有无差异。结果两组患者手术时间、X线曝光时间以及术中电压阈值、阻抗、感知水平比较,差异均无统计学意义(P>0.05)。两组患者术中急性期心搏出量、心指数、每搏量及平均肺动脉楔入压比较,差异均有统计学意义(P<0.05)。随访12个月时两组患者的左室射血分数、左室内径缩短分数、左房室瓣口E峰血流速度与左房室瓣口A峰血流速度的比值、QRS波宽度及6 m in步行距离比较,差异均有统计学意义(P<0.05)。结论 RVS起搏是安全、有效的,具有更好的急性期血流动力学效应,长期起搏时对心脏功能的影响也较少,是一种更理想的起搏方式。

Objective To compare the effects on henodynamics of acute or chronic patients by the pacing in right ventricular septum and in right ventricular apex. Methods Eighty advanced A - V block patients were randomly divided into two groups （with each group 40 cases respectively）, in which one group received RVS pacing while the other group received RVA pacing. The intraopcrative hemodynamic parameters and heart function, including ventricular pacing rate, wave width of QRS, were compared between the two groups. Results There were no statistical differences in operation time, X - ray exposure time, intraoperative threshold voltage and the level of perception resistance between the two groups （ P 〉 0.05 ）. While during operation, there were statistical differences in the stroke volume of acute phase, cardiac index, stroke volume and wedge pressure of average pulmonary artery. （P 〈 0. 05 ）. Comparing the 12 months follow - up of the two groups of patients, there were statistical differences in the fraction of left ventricular ejection, E/A, QRS wave width and six minutes of walking distance （P 〈 0. 05 ）. Conclusion RVS pacing is as safe and efficient as RVA pacing, while RVS pacing is more beneficial to the hemodynamic and brings less negative effect to heart function.