永久性人工心脏起搏器植入术后心功能变化的研究

Permanent cardiac pacemaker implantation study on changes of cardiac function

目的:分析永久性心脏起搏器植入术前后心功能的变化。方法:应用超声心动图对36例行永久性人工心脏起搏器植入的患者术前、术后(6个月)检查,其中心室按需起搏(VVI)26例、房室顺序起搏(DDD)10例,检测左室舒张末容积(EDV)、左室收缩末容积(ESV)、每搏输出量(SV)、射血分数(EF)等血流动力学指标。再应用起搏器程控仪检测心室累积起搏比例,分为<40%和≥40%组。结果:心室按需和房室顺序起搏植入术后术后各指标变化如下:①两种起搏模式比较:起搏器植术入后EDV、ESV呈增高趋势,SV及EF呈下降趋势,差异无统计学意义(P>0.05);②不同心室累积起搏比例比较:≥40%组各血流动力学指标较<40%组呈下降趋势,差异有统计学意义(P<0.05)。结论:过多的右室心尖部起搏对心功能有明显的不良影响,临床上应尽可能优化起搏参数和部位,提倡生理性起搏,保护心功能。

Objective Analysis of changes of cardiac function before and after Permanent pacemaker implantation.Methods Application ultrasonic heart figure on 36 routine permanent artificial pacemaker implantation of patients operation Qian,and operation Hou（6 months） check,which ventricular by required up beats（VVI）26 cases,and room room order up beats（DDD） 10 cases,detection left room diastolic late volume（EDV）,and left room contraction late volume（ESV）,and each beats volume（SV）,and shot blood score（EF）,blood flow dynamics index.Then apply the cumulative pacing ventricular pacemaker programmed instrument,divided into40% and ≥40%.Results Atrioventricular sequential pacing in ventricular on demand and after implantation of the index are as follows： ①12 comparison of pacing mode：after pacemaker implantation in EDV,the ESV is increasing trend,SV and EF is a downward trend,but no significant difference（P0.05）;②comparison of different ratio of accumulation of ventricular pacing：≥40% groups of hemodynamics indexes representing40% group declined,statistically significant differences（P0.05）.Conclusion Too many right ventricular Apex pacing on cardiac functions have obvious adverse effects,clinical as possible on optimizing pacing parameters and part advocate of physiological pacing,protect the heart function.