右室流出道间隔起搏与右室心尖部起搏对右心功能影响的对比分析

摘要

Objective To compare the right ventricular hemodynamic effects of right ventricular outflow tract( RVOT) pacing and right ventricular apex( RVA) pacing by using tissue Doppler imaging (TDI). Methods 72 cases implanted with DDD pacemakers were divided into RVOT group(38 cases) and RVA group(34 cases). TDI was carried out before implantation. Patients were reexamined after three months. TDI profiles of bicuspid annulus at right ventricle lateral wall were acquired at the apical four-chamber view. Results In RVOT group, Doppler tissue velocity showed that the peak systolic velocity (Sm) didn' t have apparent change (P > 0.05). The peak late diastolic velocity ( Am) and the peak early diastolic velocity( Era) increased. The ratio of Em/Am increased from 0. 70 ±0.05 to 0.92 ±0. 06(P < 0.05 ). The isovolumic contraction time( IVCT) didn' t have apparent change( P >0.05). The isovolumic relaxation time( IVRT) was shortened. Ejection time( ET) was prolonged. The myocardial performance in-dex(Tei index) were positively shortened(P <0. 05). In RAV group,Sm had no( apparent) change,the raio of Em/Am decreased from 0.76 ±0. 10 to 0.68 ±0.20 (P <0.05 ). IVCT had no change. IVRT prolonged , ET shortened. Tei index prolonged significantly ( P < 0. 05). Compared with RVA group three months after implantation,cases in RVOT group had the better hemodynamics. The ratio of Em/Am,Tei index had significantly improves(P<0. 05). Conclusions RVOT pacing improves the right ventricular diastolic function after three months implantation in patients with second or third-degree atrioventricular block. RVA pacing can aggravate the right ventricular diastolic function. Both RVOT and RVA pacing has no effects on the right ventricular systolic function.%目的 应用组织多普勒显像技术(TDI)评价右室流出道间隔部起搏(RVOT)和心尖部起搏(RVA)对右心室功能的影响.方法 72例置人DDD型起搏器的患者根据心室电极放置的部位分为RVOT起搏组(38例)和RVA起搏组(34例),术前和术后3个月测定右心室侧壁三尖瓣环处的相关TDI参数.结果 RVOT组患者术后3个月与术前相比收缩期峰值速度(Sim)无明显变化(P＞0.05)；而舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)及Em/Am均较术前有明显改善(P＜0.05)；等容收缩期时间(IVCT)无明显改变(P＞0.05),而等容舒张期时间(IVRT)缩短,射血时间(ET)延长,Tei指数由0.52±0.08下降至0.40±0.07(P ＜0.05).RAV组术后3个月与术前相比,Sm无明显变化(P＞0.05),Em/Am由0.76±0.10下降为0.68 +0.20(P ＜0.05),IVCT无明显改变,而IVRT延长,ET缩短,Tei指数由0.58±0.09上升至0.71 +0.06(P ＜0.05).术后3个月RVOT组与RAV组相比,Sm及IVCT无明显变化,而反映舒张功能的主要指标Em/Am、Tei指数有显著改善(P＜0.05).结论 RVOT起搏能够改善依赖心室起搏的Ⅱ度或Ⅲ度房室传导阻滞患者3个月时的右心室舒张功能,而RVA起搏则会使此类患者右心室舒张功能恶化,两种不同部位起搏对右室的收缩功能影响不显著.