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目的探讨右室高位室间隔(HRVS)与右室心尖部(RVA)起搏对心室收缩同步性和心功能的影响及其机制,为右室高位室间隔起搏的临床应用提供理论基础。方法将具有行永久性双腔心脏起搏器植入术指征的77例患者,根据心室起搏电极植入部位的不同,随机分为HRVS起搏组(40例)和RVA起搏组(37例)。分别于术前、术后3个月和术后18个月,通过询问病史、查体、心电图和超声心动图检查对患者的一般临床状况、QRS波群时限(QRSd)、左右室射血前时间差值(LRVPEI)、室间隔与左室后壁收缩延迟时间(SPWMD)、左室射血分数(LVEF)进行观察随访。同时运用起搏器程控仪对患者术后3个月和18个月的起搏房室间期、心室起搏比例等起搏相关参数进行监测和调控。最后对两组患者的上述指标进行对比研究和统计学分析。结果两组患者一般临床特征及术前各项观察指标均无明显差别。术后3个月时,两组患者起搏相关参数均无显著差别(P<0.05),△HRVS起搏组的△QRSd、△LRVPEI和△SPWMD均明显小于RVA起搏组(P<0.05),LVEF无显著差别(P<0.05)。术后18个月时,两组患者间起搏相关参数没有明显差别,△QRSd、△LRVPEI和SPWMD三项指标的差别更加明显(P<0.01),并且△HRVS起搏组的△LVEF明显高于RVA起搏组(P<0.01)。两组病人术前及术后18个月时LVEF的变化值(△LVEF)与相应时间的△QRSd、△LRVPEI和△SPWMD的变化值(△QRSd、△LRVPEI和△SPWMD)呈明显负相关。结论△HRVS起搏组心室间及心室内电和机械活动的同步性明显优于RVA起搏组。虽然对心脏功能的短期影响两者间没有明显差别,但长期起搏时,△HRVS起搏对患者的心功能的不良影响明显小于RVA起搏。
Objective To investigate the effects and mechanisms of right ventricular high compartment (HRVS) and right ventricular apex (RVA) pacing on the systolic and ventricular systolic function and provide the theoretical basis for the clinical application of high ventricular septal pacing. Methods Seventy-seven patients with permanent dual-chamber pacemaker implantation were randomly divided into HRVS pacing group (n = 40) and RVA pacing group (n = 37 cases). The patients’ general clinical status, QRS complex time (QRSd), left ventricle ejection and left ventricular ejection fraction were determined by examining history, examination, electrocardiogram and echocardiography before surgery, 3 months and 18 months after operation. LRVPEI, SPWMD and LVEF were observed and followed up. At the same time, pacemaker programmer was used to monitor and control the pacing parameters such as pacing atrial and ventricular pacing rate at 3 months and 18 months after operation. Finally, the two indicators of these patients were compared and statistical analysis. Results The general clinical features of the two groups of patients and the preoperative indicators did not show any significant difference. At 3 months after operation, there was no significant difference in pacing parameters between the two groups (P <0.05). △ QRSd, △ LRVPEI and △ SPWMD in △ HRVS pacing group were significantly lower than those in RVA pacing group (P <0.05) , LVEF no significant difference (P <0.05). There was no significant difference in pacing parameters between the two groups at 18 months after operation. The differences of △ QRSd, △ LRVPEI and SPWMD were more significant (P <0.01), and △ LVEF of △ HRVS pacing group was significantly higher In RVA pacing group (P <0.01). The change of LVEF (△ LVEF) and the change of △ QRSd, △ LRVPEI and △ SPWMD (△ QRSd, △ LRVPEI and △ SPWMD) at the corresponding time were significantly negative correlation between the two groups before and 18 months after operation. Conclusion △ HRVS pacing group, the interventricular and ventricular electrical and mechanical synchronization was significantly better than the RVA pacing group. Although short-term effects on cardiac function were not significantly different, long-term pacing, △ HRVS pacing on patients with adverse cardiac function was significantly less than RVA pacing.