右心室不同部位起搏对心功能的影响

Effect on human left ventricle function of different sites pacing in right ventricle

目的研究右心室不同部位起搏对患者心功能的影响,探求最有利的永久性右心室起搏部位。方法 54例Ⅱ度Ⅱ型或Ⅲ度房室传导阻滞行永久性起搏器的患者,按起搏部位分为右心室心尖(RVA)组、右心室流出道(RVOT)组、右心室流入道(RVIT)组,分别观察三组术前及术后6个月QRS间期(QRSd)、左心室射血分数(LVEF)、每搏输出量(SV)、每分输出量(CO)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)的差异,并比较三组间术后6个月上述参数的差异。结果与术前相比,三组起搏术后6个月QRSd均显著增加(P<0.01);RVA组起搏术后6个月LVEF、SV、CO均显著降低(P<0.05);RVOT组与RVIT组起搏术后6个月LVEF、SV、CO均无显著变化(P>0.05);三组起搏术后6个月LVESD、LVEDD均无显著变化(P>0.05)。三组间起搏后6个月QRSd有统计学差异,QRSd依次为RVA组>RVOT组>RVIT组(P<0.01);而三组间起搏后6个月LVEF、SV、CO、LVESD、LVEDD无统计学差异(P>0.05)。结论右心室流入道起搏QRSd最小,可能是理想的右心室起搏部位。

Objective To compare the intermediate stage effects on human left ventricle function of pacing in right ventricular septum, in right ventricular outflow tract and in right ventricular inflow tract and to find the best right ventricular permanent pacing sites. Methods 54 patients who suffered Ⅱ°ⅡAVB or Ⅲ°AVB performed with pacing were grouped into three terms, RVA pacing, RVOT pacing, RVIT pacing. The haemodynamics parameters including QRS duration（QRSd）, left ventricular ejection fraction（LVEF）, stroke volume（SV）, cardiac output（CO）, left ventricular end-diastolic diameter（LVEDD）, left ventricular end-systolic diameter（LVESD） which were compared between preoperation and 6 months after operation. Among three terms, the haemodynamics parameters of 6 months after operation were compared one by one. Results Compared with the haemodynamics parameters of preoperation, the QRSd in the RVA group, the RVOT group, and the RVIT group of 6 months after operation increased significantly（P〈0.01）; the LVEF, SV, CO of the RVA gropes of 6 months after operation decreased significantly（P〈0.05）; the LVEF, SV, CO of the RVOT group and the RVIT group of 6 months after operation didn＇t decrease significantly（P〉0.05）; the LVESD and LVEDD of three groups didn＇t increase significantly（P〉0.05）. Compared the haemodynamics parameters of 6 months after operation among the RVA group, the RVOT group, the RVIT group, the QRSd of three groups were different significantly 6 months after operation（P〈0.01）; the EF, SV,CO, LVESD and LVEDD of three groups weren＇t different significantly 6 months after operation（P〉0.05）. Conclusion Right ventricular inflow tract pacing have an advantage over the haemodynamics parameters of the RVA pacing and the RVOT pacing and approach the physiological pacing. Right ventricular inflow tract may be the best site of pacing right ventricular.