右室不同部位起搏對左室收縮同步性及整體收縮功能早期影響的實時三維超聲心動圖研究
發(fā)布時間：2018-10-23 12:19
【摘要】：背景右室心尖部由于肌小梁豐富，起搏器電極易放置，脫位率低，故長期以來臨床上通常選擇右室心尖部起搏作為永久心臟起搏器的植入部位。但近年來，國內外相關研究表明，長期的右室心尖部起搏可導致心室肌電-機械活動的異常，從而影響心肌收縮同步性及心功能。右室流出道起搏是近幾年應用于臨床的一項新的起搏技術，因其起搏位點更接近正常心臟傳導路徑，理論上可獲得更生理的心肌傳導順序而備受關注。不同部位起搏對左室收縮同步性及心功能的早期影響還有待進一步的研究，實時三維超聲心動圖作為近年來應用于臨床的一項超聲新技術，可在同一心動周期同時比較左室壁16節(jié)段的收縮同步性及心功能。 目的探討應用實時三維超聲心動圖(real-time three-dimensional echocardiography,RT-3DE)評價右室不同部位起搏對左室收縮同步性及整體收縮功能的早期影響。方法60例房室順序雙心腔起搏、感知觸發(fā)和抑制型（dual-chamber demand, DDD）起搏器植入的患者，根據(jù)起搏部位不同分為右室流出道（right ventricular outflow tract,RVOT）組及右室心尖（right ventricular apex pacing, RVAP)組。兩組患者均于術前及術后1周應用RT-3DE采集左心室全容積圖像并應用在機Qlab8.1分析軟件，獲得左心室整體與16節(jié)段容積-時間曲線和左心室16節(jié)段（包括6個基底段6個中間段和4個心尖段）、12節(jié)段（包括6個基底段和6個中間段）、6節(jié)段（6個基底段）自心電圖QRS波起點至左心室最小收縮末容積點時間的標準差和最大時間差(即Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)作為左室收縮同步性參數(shù)；同時獲得左心室舒張末期容積(1eft ventricle end-diastolic volume, LVEDV)、左心室收縮末期容積(1eft ventricular end-systolic volumes, LVESV)、每搏量(stroke volume, SV)、左心室射血分數(shù)(1eft ventricular ejection fraction, LVEF)作為左室整體收縮功能參數(shù)。將上述左室同步性參數(shù)及整體收縮功能參數(shù)進行組內術前術后比較及組間同期比較。 結果1. RVAP組與RVOT組在年齡、性別、心率、左室射血分數(shù)方面差異無統(tǒng)計學意義（p0.05）。2.術前RVAP組與RVOT組在左室同步性參數(shù)及左室整體收縮功能參數(shù)方面比較均無統(tǒng)計學差異（p0.05）。術后一周，RVAP組左室收縮同步性參數(shù)(即Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)與術前比較明顯延長（P0.05），與RVOT組同期比較亦明顯延長（P0.05），RVOT組左室同步性參數(shù)術后與術前比較無統(tǒng)計學差異（p0.05）。3.左室整體收縮功能參數(shù)(LVEDV、LVESV、SV、LVEF)在RVAP組與RVOT組組內術前術后比較及術后組間比較均無統(tǒng)計學差異（p0.05）。 結論1.RVAP早期就可導致左室收縮同步性下降，，與RVAP起搏比較，RVOT起搏更有利于起搏狀態(tài)下左室同步性收縮，是一種更符合生理的起搏方式。2.RVOT起搏與RVAP在起搏早期均未影響左室整體收縮功能。3.RT-3DE可客觀、準確地評價左室收縮同步性及整體收縮功能。
[Abstract]:Background due to the rich trabeculae, easy placement of pacemaker electrodes and low dislocation rate, the right ventricular apex pacing is usually chosen as the implantation site of permanent cardiac pacemakers in clinic for a long time. However, in recent years, studies at home and abroad have shown that long-term right ventricular apex pacing can lead to abnormal electromyography and mechanical activity of the ventricle, thus affecting the synchronism of myocardial contraction and cardiac function. Right ventricular outflow tract pacing (RVOT) is a new pacing technique applied in clinic in recent years. It has attracted much attention because its pacing site is closer to normal cardiac conduction pathway and more physiological cardiac conduction sequence can be obtained theoretically. The effects of different pacing sites on left ventricular systolic synchrony and cardiac function need to be further studied. Real-time three-dimensional echocardiography is a new ultrasound technique applied in clinic in recent years. Systolic synchrony and cardiac function of 16 segments of left ventricular wall can be compared simultaneously in the same cardiac cycle. Objective to evaluate the early effects of different right ventricular pacing on left ventricular systolic synchrony and global systolic function by real time three dimensional echocardiography (real-time three-dimensional echocardiography,RT-3DE). Methods Sixty patients with atrioventricular sequential biventricular pacing, perceptual trigger and inhibition (dual-chamber demand, DDD) pacemaker implantation) were divided into right ventricular outflow tract (right ventricular outflow tract,RVOT) group and right ventricular apex (right ventricular apex pacing, RVAP) group according to the location of pacing. The left ventricular full volume images were collected by RT-3DE before operation and 1 week after operation, and the Qlab8.1 analysis software was used in both groups. The left ventricular global and 16 segmental volume-time curves and left ventricular 16 segments (including 6 basal segments, 6 intermediate segments and 4 apical segments), 12 segments (including 6 basal segments and 6 middle segments), 6 segments (6 basal segments), and 6 segments (6 basal segments) were obtained. The standard deviation and maximum time difference (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) from the beginning of QRS wave to the minimum end-systolic volume point of left ventricle (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) were used as the synchronization parameters of left ventricle. At the same time, left ventricular end-diastolic volume (1eft ventricle end-diastolic volume, LVEDV),) left ventricular end-systolic volume (1eft ventricular end-systolic volumes, LVESV), volume per stroke) (stroke volume, SV), left ventricular ejection fraction (1eft ventricular ejection fraction, LVEF) was obtained as a parameter of global left ventricular systolic function. The parameters of left ventricular synchrony and global systolic function were compared before and after operation and at the same time. Result 1. There was no significant difference in age, sex, heart rate and left ventricular ejection fraction between RVAP group and RVOT group (p0.05). There was no significant difference between RVAP group and RVOT group in the parameters of left ventricular synchronism and left ventricular global systolic function (p0.05). One week after operation, the left ventricular systolic synchronism (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) in RVAP group was significantly longer than that in preoperative group (P0.05), and that in RVOT group was significantly longer than that in RVOT group (P0.05). There was no significant difference between), RVOT group and pre-operation group (p0.05). There was no significant difference in left ventricular global systolic function (LVEDV,LVESV,SV,LVEF) between RVAP group and RVOT group before and after operation (p0.05). Conclusion compared with RVAP pacing, RVOT pacing is more beneficial to the synchronous contraction of left ventricle in the early stage of 1.RVAP. 2.RVOT pacing and RVAP pacing did not affect the global left ventricular systolic function in the early stage of pacing. 3.RT-3DE can objectively and accurately evaluate the left ventricular systolic synchrony and global systolic function.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R540.45
本文編號：2289214
[Abstract]:Background due to the rich trabeculae, easy placement of pacemaker electrodes and low dislocation rate, the right ventricular apex pacing is usually chosen as the implantation site of permanent cardiac pacemakers in clinic for a long time. However, in recent years, studies at home and abroad have shown that long-term right ventricular apex pacing can lead to abnormal electromyography and mechanical activity of the ventricle, thus affecting the synchronism of myocardial contraction and cardiac function. Right ventricular outflow tract pacing (RVOT) is a new pacing technique applied in clinic in recent years. It has attracted much attention because its pacing site is closer to normal cardiac conduction pathway and more physiological cardiac conduction sequence can be obtained theoretically. The effects of different pacing sites on left ventricular systolic synchrony and cardiac function need to be further studied. Real-time three-dimensional echocardiography is a new ultrasound technique applied in clinic in recent years. Systolic synchrony and cardiac function of 16 segments of left ventricular wall can be compared simultaneously in the same cardiac cycle. Objective to evaluate the early effects of different right ventricular pacing on left ventricular systolic synchrony and global systolic function by real time three dimensional echocardiography (real-time three-dimensional echocardiography,RT-3DE). Methods Sixty patients with atrioventricular sequential biventricular pacing, perceptual trigger and inhibition (dual-chamber demand, DDD) pacemaker implantation) were divided into right ventricular outflow tract (right ventricular outflow tract,RVOT) group and right ventricular apex (right ventricular apex pacing, RVAP) group according to the location of pacing. The left ventricular full volume images were collected by RT-3DE before operation and 1 week after operation, and the Qlab8.1 analysis software was used in both groups. The left ventricular global and 16 segmental volume-time curves and left ventricular 16 segments (including 6 basal segments, 6 intermediate segments and 4 apical segments), 12 segments (including 6 basal segments and 6 middle segments), 6 segments (6 basal segments), and 6 segments (6 basal segments) were obtained. The standard deviation and maximum time difference (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) from the beginning of QRS wave to the minimum end-systolic volume point of left ventricle (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) were used as the synchronization parameters of left ventricle. At the same time, left ventricular end-diastolic volume (1eft ventricle end-diastolic volume, LVEDV),) left ventricular end-systolic volume (1eft ventricular end-systolic volumes, LVESV), volume per stroke) (stroke volume, SV), left ventricular ejection fraction (1eft ventricular ejection fraction, LVEF) was obtained as a parameter of global left ventricular systolic function. The parameters of left ventricular synchrony and global systolic function were compared before and after operation and at the same time. Result 1. There was no significant difference in age, sex, heart rate and left ventricular ejection fraction between RVAP group and RVOT group (p0.05). There was no significant difference between RVAP group and RVOT group in the parameters of left ventricular synchronism and left ventricular global systolic function (p0.05). One week after operation, the left ventricular systolic synchronism (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) in RVAP group was significantly longer than that in preoperative group (P0.05), and that in RVOT group was significantly longer than that in RVOT group (P0.05). There was no significant difference between), RVOT group and pre-operation group (p0.05). There was no significant difference in left ventricular global systolic function (LVEDV,LVESV,SV,LVEF) between RVAP group and RVOT group before and after operation (p0.05). Conclusion compared with RVAP pacing, RVOT pacing is more beneficial to the synchronous contraction of left ventricle in the early stage of 1.RVAP. 2.RVOT pacing and RVAP pacing did not affect the global left ventricular systolic function in the early stage of pacing. 3.RT-3DE can objectively and accurately evaluate the left ventricular systolic synchrony and global systolic function.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R540.45
【參考文獻】
相關期刊論文 前5條
1 朱參戰(zhàn),張全發(fā),崔長琮,薛小臨,傅文,劉維維,劉引會,徐琳;右室單雙部位起搏對心功能和QRS寬度的影響[J];心臟雜志;2003年01期
2 李青,王夢洪,吳印生,顏瓊;兩種電極導線在心室起搏臨床應用中的比較[J];心臟雜志;2005年05期
3 曾欣;右室心尖部起搏的心室激動順序對心功能的影響及可能機制[J];中國心臟起搏與心電生理雜志;2001年04期
4 舒先紅,潘翠珍,施月芳,崔潔,黃國倩,劉詩珍,潘文明,陳灝珠;實時三維超聲心動圖評價左心室心肌收縮同步性的初步臨床研究[J];中華超聲影像學雜志;2005年09期
5 孫華偉;陸X;林紅;;正常成人室間隔左右心室面結構與功能關系的超聲心動圖研究[J];中華臨床醫(yī)師雜志(電子版);2008年05期
本文編號：2289214
本文鏈接：http://sikaile.net/yixuelunwen/fangshe/2289214.html
最近更新
教材專著
