双腔起搏器患者术后房室间期的程控管理

The Management of Atiroventricualr Period Program in Patients with Dual Chamber Pacemaker

目的:探讨最佳房室间期(AVD)的设置和管理方法。方法:选择因高度或完全性房室传导阻滞而安置双腔起搏器的患者,研究组(23例)通过超声心动图指导进行感知房室间期的优化,对照组(21例)则常规设置房室间期。对比起搏器植入后1周和7个月2组患者超声心动图的变化以及心房颤动和心力衰竭的发生率。结果:(1)研究组的AVD为(138.7±8.7)ms,对照组的AVD为(124.8±0.8)ms(P<0.001)。(2)起搏器植入后1周,2组患者的超声心动图指标无显著差异。(3)随访结束时,研究组与对照组相比,左房内径分别为(36±2.8)mm和(38.7±3.4)mm,P=0.008;左室内径分别为(46.7±4.5)mm和(49.4±5.2)mm,P=0.07,对照组的左心房、左心室较研究组相对增大。E波最大血流速度-时间积分分别为(13.2±0.9)和(9.9±1.7);A波最大血流速度-时间积分分别为(5.1±0.9)和(4.1±0.9);左心室射血分数分别为(58.6±2.2)%和(55.3±4.1)%;每搏量分别为(63±5.2)mL和(54.9±6.6)mL,对照组患者的心功能明显降低。结论:最佳房室间期起搏有利于患者的心功能,超声心动图是指导房室间期设置的简便而可靠手段。

Objective：To evaluate the management of optimal atrioventricular delay（AVD） in patients received dual chamber pacemaker.Methods： A total of 44 patients with pacemakers due to high-degree or complete atrioventricular conduction block were divided into 2 groups.The sensed AVDs of patients in study group were programmed under the direction of ultrasound,while patients in the control group were programmed by experience.All patients were examined and compared by echocardiography at baseline and the end of follow-up.Results：（1）The AVDs were different in 2 groups,（138.7±8.7） ms in the study group,while（124.8±0.8）ms in the control group,P0.001.（2）The results of echocardiography were similar in two groups at baseline.（3）In the end of follow-up,the diameters of left atria in study and control group were（36±2.8） and（38.7±3.4） mm,respectively.P=0.008;the diameters of left ventricle were（46.7±4.5） and（49.4±5.2） mm,respectively,P=0.07.The left atria and ventricle were enlargement in control group.The Ei in 2 groups were（13.2±0.9） and（9.9±1.7）;Ai were（5.1±0.9） and（4.1±0.9）;left ventricular ejection fractions were（58.6±2.2）% and（55.3±4.1）%;stroke volumes were（63±5.2） and（54.9±6.6）ml,respectively,P0.05.The function of the heart in patients in control group was reduced comparably.Conclusions：The optimal AVD benefit the function of the heart in patients with dual chamber pacemakers,and echocardiography is a simple and valid tool for evaluating the optimal AVD.