發(fā)布時(shí)間：2018-11-15 07:02

【摘要】：目的:植入式心臟轉(zhuǎn)復(fù)除顫儀(ICD)的感知功能是其發(fā)揮除顫功能的前提,ICD植入術(shù)中利用起搏分析儀所測得的R波振幅是ICD感知功能正常工作的基礎(chǔ)。本研究旨在通過對比分析不同品牌ICD與起搏分析儀術(shù)中所測參數(shù)的差異來幫助臨床醫(yī)師了解不同品牌ICD的特點(diǎn)。方法:入選2015年9月至2015年12月在南京鼓樓醫(yī)院心臟科因心律失常需植入心血管植入電子裝置(CIED)的患者。術(shù)前收集其臨床基本資料及相關(guān)檢查結(jié)果,術(shù)中利用不同品牌ICD樣機(jī)和5318起搏分析儀分別測試R波振幅、阻抗等參數(shù),并通過程控分析儀打印ICD所記錄的腔內(nèi)心電圖。術(shù)后手動(dòng)測量腔內(nèi)心電圖上的R波振幅及T波振幅并計(jì)算兩者差值,定義該值為R波安全余量。利用配對t檢驗(yàn)比較不同品牌ICD及5318起搏分析儀所測得的R波振幅、阻抗及不同品牌ICD所對應(yīng)的R波安全余量,觀察并比較不同品牌ICD所感知腔內(nèi)心電圖形態(tài)。結(jié)果:共30例患者入選本研究,最終獲得了 30例患者的起搏分析儀所測R波振幅及阻抗,30例患者美敦力ICD、波科ICD及百多力ICD所感知的R波振幅、阻抗及腔內(nèi)心電圖,22例患者圣猶達(dá)ICD所感知的R波振幅、阻抗及腔內(nèi)心電圖。研究發(fā)現(xiàn):1.同一患者不同品牌ICD所感知的腔內(nèi)心電圖所示QRS波主要有"qR""、"rSr"、"RQr"這3種形態(tài),T波主要有被完全濾過或過濾為負(fù)向波形這兩種處理結(jié)果。2.術(shù)中5318起搏分析儀所測得R波振幅平均為14.1±4.3mv,高于不同品牌ICD所測R波振幅,有統(tǒng)計(jì)學(xué)差異(P≤0.001),美敦力ICD所測R波振幅最低,為7.9±3.1mv。3.手測腔內(nèi)心電圖R波振幅與機(jī)測值存在一定差異,百多力ICD和波科ICD所測R波振幅與腔內(nèi)心電圖R波振幅手測值得差異無統(tǒng)計(jì)學(xué)意義。在R波安全余量方面,波科ICD腔內(nèi)心電圖R波安全余量最高為12.0±3.1mv,僅圣猶達(dá)ICD腔內(nèi)心電圖R波安全余量與之相比無統(tǒng)計(jì)學(xué)差異(12.0±3.1mvVS10.9±2.6mv,P=0.667)。4.不同品牌ICD術(shù)中測試導(dǎo)線阻抗與5318起搏分析儀術(shù)中測試阻抗的差異有統(tǒng)計(jì)學(xué)意義,5318起搏分析儀所測阻抗最高為 823±261 Ω。結(jié)論:1.不同品牌ICD感知的腔內(nèi)心電圖形態(tài)不同,R波振幅、T波振幅及形態(tài)存在明顯差異,這可能與不同品牌ICD采用的感知算法及帶通濾波器不同有關(guān);2.不同品牌ICD術(shù)中測試的R波振幅低于5318起搏分析所測R波振幅,且不同品牌ICD所測R波振幅之間也存在差異,這提示在ICD植入術(shù)中利用5318起搏分析儀測定R波振幅時(shí)對應(yīng)不同品牌ICD存在不同的最低要求值;不同品牌ICD的R波安全余量存在差異,該差異可能與不同品牌ICD的T波過感知發(fā)生率有關(guān),其臨床意義還有待進(jìn)一步探索;3.不同品牌ICD術(shù)中所測導(dǎo)線阻抗與5318起搏分析儀所測導(dǎo)線阻抗存的差異有統(tǒng)計(jì)學(xué)意義,但該差異不足以影響術(shù)后利用阻抗變化幅度判斷導(dǎo)線完整性的功能。
[Abstract]:Aim: the perceptual function of (ICD) is the premise of defibrillation. The amplitude of R wave measured by pacing analyzer in ICD implantation is the basis of normal function of ICD. The purpose of this study was to help clinicians understand the characteristics of different brands of ICD by comparing and analyzing the differences of intraoperative parameters between different brands of ICD and pacemaker analyzers. Methods: from September 2015 to December 2015, patients in Department of Cardiology of Nanjing Gulou Hospital needed to implant cardiovascular device (CIED) due to arrhythmia. The basic clinical data and related examination results were collected before operation. The parameters of R wave amplitude and impedance were measured by different brand ICD prototype and 5318 pacemaker analyzer respectively. The intracavitary electrocardiogram recorded by ICD was printed by program control analyzer. The R wave amplitude and T wave amplitude were measured manually after operation and the difference between them was calculated, which was defined as the R wave safety margin. The R wave amplitude, impedance and R wave safety margin of different brands of ICD and 5318 pacemaker analyzer were compared by paired t test, and the electrocardiogram (ECG) patterns of different brands of ICD were observed and compared. Results: a total of 30 patients were enrolled in this study. The R wave amplitude and impedance measured by pacemaker analyzer were obtained in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) were detected by Medtronic ICD, wave ICD and Baidol ICD in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) perceived by St Juda ICD in 22 patients. The results are as follows: 1. The QRS waves perceived by different brands of ICD in the same patient were mainly "qR", "rSr" and "RQr", and T waves were completely filtered or filtered into negative waveforms. 2. The average amplitude of R wave measured by 5318 pacing analyzer during operation was 14.1 鹵4.3 MV, which was higher than that measured by different brands of ICD (P 鈮，

本文編號：2332489