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目的比较右室流出道间隔部(RVS)与右室心尖部(RVA)起搏对血流动力学的影响。方法选择具备起搏器植入指征的患者30例,随机分为RVA组与RVS组,采用超声心动图检测左室射血分数(LVEF)、每搏量(SV)、左室短轴缩短率(FS)、心脏指数(CI),对比观察术前、术后3,6个月差异。并比较术前与术后心电图QRS波宽度。结果两组患者均顺利完成手术。两组QRS波时限均较自身心律时延长,差异有统计学意义(P<0.01),RVA组起搏QRS时限显著长于RVS组[(158±15)msvs(132±15)ms,P<0.01];RVA组术后3个月随访LVEF,SV,FS,CI较术前均显著降低,均有统计学意义[(59±3)%vs(51±3)%,(79±15)mlvs(71±16)ml,(0.36±0.11)vs(0.31±0.09),(2.5±0.4)L/(min·m2)vs(2.1±0.4)L/(min.m2),均P<0.05];RVS组术后3,6个月随访LVEF,SV,FS,CI与术前无显著性差异,RVS组3,6个月随访LVEF,SV,FS,CI均显著高于同期RVA组,均有统计学意义(均P<0.05)。结论RVS起搏尽可能的保证了心室激动和收缩同步性,实现了比RVA起搏较为良好的血流动力学状态。
Objective To compare hemodynamic effects of right ventricular apex (RVA) pacing with right ventricular outflow tract septal (RVS). Methods Thirty patients with indications of pacemaker implantation were randomly divided into RVA group and RVS group. The left ventricular ejection fraction (LVEF), stroke volume (SV), shortening of left ventricular short axis Rate (FS) and cardiac index (CI) were compared between preoperative and postoperative 3,6 months. The preoperative and postoperative ECG QRS wave width was compared. Results Both groups completed the operation smoothly. The duration of QRS in both groups was significantly longer than that in RVS group [(158 ± 15) ms vs (132 ± 15) ms, P <0.01 ]. The LVEF, SV, FS and CI in the RVA group were significantly lower than those before the operation at 3 months of follow-up [(59 ± 3)% vs (51 ± 3)% and (79 ± 15) ml vs (71 ± 16) ml, (0.36 ± 0.11) vs (0.31 ± 0.09), (2.5 ± 0.4) L / (min · m2) vs (2.1 ± 0.4) L / (min.m2) . There was no significant difference in LVEF, SV, FS, CI between 3 and 6 months after operation in RVS group. LVEF, SV, FS and CI were significantly higher in RVS group than those in RVA group There was statistical significance (all P <0.05). Conclusions RVS pacing can ensure the synchronization of ventricular activation and contraction as much as possible and achieve a better hemodynamic status than RVA pacing.