右心室流出道起搏对左心室功能变化的影响

摘要

目的 探讨右心室流出道部位起搏对患者左心室功能变化的影响. 方法 选择符合起搏器植入指征患者48例,按照右心室不同起搏部位分为右室心尖部起搏组( RVAP)及右室流出道部起搏组( RVOT) ,观察两组患者起搏器植入术前及术后12个月血浆BNP水平、心电图QRS波时限、左室收缩末期内径( LVEDV)、左室舒张末期内径( LVESV)、左室射血分数(LVEF)等指标. 结果 RVAP组患者术后12个月血浆BNP水平(762 ± 19)pg/mL明显高于术前(561 ± 15) pg/mL(P<0. 05), RVOT组患者血浆BNP水平术前(539 ± 13)pg/mL与术后(612 ± 17)pg/mL比较差异无统计学意义(P>0. 05);术后RVAP组患者心电图QRS时限最宽(P<0. 05),RVOT组患者最窄(P<0. 05);术后RVAP与RVOT组患者左心室收缩末期前后径、舒张末期前后径、射血分数与术前比较差异均无统计学意义( P>0. 05 ). 结论 选择右心室流出道部位起搏,患者血浆BNP水平最低、起搏QRS时限最窄,可能是理想的右心室起搏部位.%Objective To evaluate the effect of outflow tract pacing of right ventricle on the left ventricular systolic func-tion by comparing. Methods 48 patients with implanted DDD or VVI pacemaker,in accordance with the right ventrieular different pacing sites were randomly divided into two groups:right ventricular apex pacing( RVAP) and right ventricular outflow tract pacing ( RVOT) . Plasma BNP, QRS wave duration,left ventricular end systolic diameter ( LVESV) , left ventricular end diastolic diame-ter( LVEDV) ,left ventricular ejection fraction( LVEF) were recorded and compared before and 12 months after pacemaker implan-tation. Results Plasma BNP levels were increased in RVAP compared before and 18 months after pacemaker implantation ( P<0. 05). There is no statistical difference in RVOT(P>0. 05). Among the two groups,the QRS wave duration was the most widest in RVAP,while the QRS wave duration was the narrowest in RVOT group(P<0. 05). The LVEDV, LVESV, LVEF were no chan-ges in RVSP or RVOT groups(P>0. 05). Conclusion The QRS wave duration was narrow and the plasma BNP was lower for the right ventfieular outflow tract pacing. May be the pacing site ideal for patients.