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目的通过比较体表心电图起搏QRS波群的时限,判断心脏超声和传统X线透视对右室起搏部位的定位差异。方法置入永久性心脏起搏器患者60例,固定角度的X线下将右室起搏部位分成高位间隔、低位间隔和心尖部三组。心脏超声对上述患者重新定位,同样进行上述分组。比较这两种方法对起搏部位定位的差异及两种评价方法起搏QRS波群时限的差异。结果(1)心脏超声与X线评价电极位置为间隔部患者QRS时限分别为0.133±0.008 s和0.141±0.009 s,前者较后者明显缩短(P<0.05)。两种方法评价为非间隔的患者QRS时限分别为0.161±0.011 s和0.163±0.012 s,两者无显著差异(P>0.05)。两种方法评价为高位间隔组的QRS时限无显著差异(0.136±0.009 s vs 0.134±0.008 s,P>0.05)。X线评价为低位间隔组的QRS时限较心脏超声评价为低位间隔组长(0.149±0.010 s vs 0.133±0.011 s,P<0.05)。(2)X线定位于间隔的40例心脏彩超下可见电极位于右室间隔31例,非间隔部位9例(其中包括2例位于右室游离壁,7例位于右室心尖部),两者比较存在显著差异(P<0.05)。X线评价为间隔而超声评价为非间隔的9例患者QRS时限,与X线和超声均评价为间隔的31例患者QRS时限比较为0.163±0.010 s vs 0.133±0.008 s(P<0.05),两组存在显著差异。结论心脏超声与X线透视对右室起搏部位的判断存在差异,超声对右室起搏电极位置的评价明显优于X线。
OBJECTIVE: To compare the positioning of right ventricular pacing site with echocardiography and conventional radiography by comparing the duration of QRS wave of surface electrocardiogram pacing. Methods Sixty patients with permanent pacemaker were divided into three groups according to the fixed angle of the right ventricular pacing: high interval, low interval and apex. Echocardiography was repositioned for the above patients and the same grouping was performed. Compare the difference between these two methods in the localization of pacing site and the difference between two evaluation methods for pacing QRS complex. Results (1) The QRS duration of echocardiography and X-ray evaluation in patients with interval electrodes was 0.133 ± 0.008 s and 0.141 ± 0.009 s, respectively. The former was significantly shorter than the latter (P <0.05). QRS duration was 0.161 ± 0.011 s and 0.163 ± 0.012 s, respectively, in patients who were evaluated as non-compartmentalized. There was no significant difference between the two methods (P> 0.05). There was no significant difference in QRS duration between the two methods (0.136 ± 0.009 s vs 0.134 ± 0.008 s, P> 0.05). The QRS duration of X-ray assessment of the low-interval group was lower than that of the echocardiographic group (0.149 ± 0.010 s vs 0.133 ± 0.011 s, P <0.05). (2) In the 40 cases undergoing X-ray echocardiography, X-ray was located in 31 cases of right ventricular septum, 9 cases of non-septal site (including 2 cases in the right ventricular free wall and 7 cases in the right ventricular apex) There were significant differences (P <0.05). The QRS duration of 9 patients with non-septal radiographic evaluation of the interval was significantly lower than that of the 31 patients assessed with interval radiography by both X-ray and ultrasound (0.163 ± 0.010 vs. 0.133 ± 0.008 s, P <0.05) There are significant differences between the two groups. Conclusions Echocardiography and X-ray are used to judge the right ventricular pacing site. Ultrasound is superior to X-ray in evaluating the location of right ventricular pacing electrode.