右心室不同部位起搏对患者心电图及心功能的比较研究
摘要
目的:比较右心室不同部位起搏对患者起搏参数、心电图、心室同步性和心功能的影响,并对研究指标进行相关性分析,为右心室间隔部起搏(RVSP)的临床应用提供理论基础.方法:选择在我院进行永久性心脏起搏器植入的患者168例,分为RVSP组(82例)和右心室心尖部起搏(RVAP)组(86例).比较两组患者术后1个月的起搏阈值、感知阈值及电极阻抗的变化并评估不良反应发生情况;测量术前、术后即刻和术后12个月两组患者心电图QRS波群时限;分别于术前和术后12个月进行心脏超声检查,比较LVEDD、LVEF和Tie指数;对LVEF的影响因素进行相关性分析.结果:RVSP和RVAP组在术后1个月起搏阈值、感知阈值及电极阻抗相比较,差异无统计学意义(P>0.05),未发生不良反应;经术后即刻和术后12个月,RVSP和RVAP患者起搏心电图QRS波群时限均较术前明显延长,且RVAP起搏心电图QRS时限RVSP延长程度更大,差别有统计学意义(P<0.01);术后12个月RVAP组的LVEF较术前降低,LVEDD较术前明显增大(P<0.01),RVSP术前后相比较,LVEDD和LVEF差别无统计学意义(P>0.05),RVSP的Tei指数显著低于RVAP,差别有统计学意义(P<0.01);LVEF与QRS时限呈负性相关.结论:RVSP较RVAP更有利于心室肌收缩的同步性,对心功能的影响较小,值得临床推广应用.
引文
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[12]张涛,商丽华,崔建,等.右心室流出道与右心室心尖部起搏对心室收缩同步性和心功能的影响[J].岭南心血管病杂志,2013,19(1):28-31.
[2]Wang F,Shi H,Sun Y,et al.Right ventricular outflow pacing induces less regional wall motion abnormalities in the left ventricle compared with apical pacing[J].Europace,2012,14(3):351.
[3]胡军,蒋利成,李阳,等.右室流出道不同部位起搏患者体表心电图的特点[J].中国循证心血管医学杂志,2016,8(3):305-307.
[4]中华医学会心电生理和起搏分会起搏学组.植入性心脏起搏器术:目前认识和建议(2010年修订版)[J].中国继续医学教育,2011,14(11):40-54.
[5]Tracy C M,Epstein A E,Darbar D,et al.2012ACCF/AHA/HRS focused update of the 2008guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardi[J].Circulation,2012,126(14):1784-800.
[6]Vanderheyden M,De B T,Rivero-Ayerza M,et al.Tailored echocardiographic interventricular delay programming further optimizes left ventricular performance after cardiac resynchronization therapy[J].Heart Rhythm,2005,2(10):1066.
[7]蔡小婕,陈国方,江隆福.右心室起搏比例和不同部位起搏对老年患者心功能的影响[J].全科医学临床与教育,2014(3):250-252.
[8]Drazner M H,Thompson B,Rosenberg P B,et al.Comparison of impedance cardiography with invasive hemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy[J].American Journal of Cardiology,2002,89(8):993.
[9]Shukla H H,Hellkamp A S,James E A,et al.Heart failure hospitalization is more common in pacemaker patients with sinus node dysfunction and a prolonged paced QRS duration.[J].Heart Rhythm the Official Journal of the Heart Rhythm Society,2005,2(3):245-51.
[10]白艳萍,田彦梅,李冬梅,等.适应性伺服通气术心力衰竭合并中枢性睡眠呼吸暂停综合征患者的循证护理实践[J].中国药物与临床,2016,16(12):1841-1843.
[11]Suzuki J,Ogimoto A,Funada J,et al.Right Ventricular Septal Pacing Preserves Global Left Ventricular Longitudinal Function in Comparison With Apical Pacing:Analysis of Speckle Tracking Echocardiography[J].Circulation Journal,2011,75(7):1609-1615.
[12]张涛,商丽华,崔建,等.右心室流出道与右心室心尖部起搏对心室收缩同步性和心功能的影响[J].岭南心血管病杂志,2013,19(1):28-31.