本文關鍵詞： 心室起搏 斑點追蹤 即時影響 心室功能 應變 應變率　出處：《河北醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:結合心電圖及二維斑點追蹤顯像技術,比較雙腔起搏器心室電極不同植入部位對心電圖特點及心室起搏對心臟功能的即時影響。方法:將病人分為回顧組及前瞻組,回顧組患者為包括病態(tài)竇房結綜合征、房室傳導阻滯及兩者均有在內的雙腔起搏器植入患者(n=131),按病歷記錄手術植入部位分為4組:中位間隔組、中下間隔組、低位間隔組、心尖組。前瞻組患者為包括病態(tài)竇房結綜合征、房室傳導阻滯及兩者均有在內的雙腔起搏器植入患者(n=85),按術后心室起搏比例分為3組:VP組(起搏比例≥90%)、VP-VS組(起搏比例≥80%且90%)、VS組(起搏比例80%)。回顧組根據術前及術后記錄的12導聯(lián)體表心電圖,測量QRS波時限、Tp-Te間期及R波高度。前瞻組患者術前、術后1周測量BNP,記錄12導聯(lián)體表心電圖測量QRS波時限、Tp-Te間期及R波高度,術前、術后1周及術后1周程控調節(jié)起搏模式2分鐘后(術后1周起搏器程控記錄起搏模式,若為心室起搏,起搏器程控適當延長A-V delay間期,如可能,將患者起搏模式由心室起搏調整為心室感知;若為心室感知,起搏器程控適當縮短A-V delay間期,將患者起搏模式由心室感知調整為心室起搏),采用心臟超聲二維斑點追蹤技術觀察左心功能指標:左室收縮末直徑(left ventricular end-systolic dimension,LVDs)、左室舒張末直徑(left ventricular end-diastolic dimension,LVEDd)、左室射血分數(Left ventricular ejection fraction,LVEF)、A峰、E/A值、A峰血流速度時間積分(A peak velocity time integral,A-VTI)、左心室應變(Strain,S)、左心室應變率(Strain rate,SR)。數據應用SPSS20.0統(tǒng)計軟件,計量資料經檢驗符合正態(tài)性分布和方差齊性時,采用均數±標準差(?x±s)表示,組內比較用配對t檢驗,回顧組組間比較用獨立樣本t檢驗,前瞻組組間比較采用重復測量方差分析,認為P0.05有統(tǒng)計學差異。結果:1回顧組:組內比較,中位間隔、中下隔、低位間隔、心尖組QRS波寬度術后均較術前增寬(104±27ms to 125±40 ms;103±22 ms to 139±26 ms;97±34 ms to 164±24 ms;64±35 ms to 171±57 ms)(P0.05);組間比較,術后中位間隔組QRS波寬度最短,與其他3組比較差異有統(tǒng)計學意義(P0.05)。余Tp-Te間期、R波高度組內、組間比較差異均無明顯統(tǒng)計學意義(P0.05);2前瞻組:QRS波組內比較,VP組、VP-VS組、VS組術后QRS波寬度均較術前增寬(94±11ms to 146±62ms;102±31ms to133±38ms;82±27ms to 125±34ms),差異有統(tǒng)計學意義(P0.05);組間比較,VP組、VP-VS組、VS組之間差異無明顯統(tǒng)計學意義(P0.05)。BNP組內比較,VP組、VP-VS組、VS組BNP術后較術前相比明顯下降(181±36pg/ml to 95±20pg/ml;201±69pg/ml to 102±47pg/ml;177±10pg/ml to 58±34pg/ml),差異有統(tǒng)計學意義(P0.05)。組間比較無明顯統(tǒng)計學差異(P0.05)。左心室應變(S)組內比較,VP、VP-VS、VS組術前、術后1周及術后程控左心室應變差異有統(tǒng)計學意義(P0.05),其中VP組(-19.0±0.9%、-13.6±4.5%、-15.4±4.4%)、VP-VS組(-21.0±5.2%、13.3±5.6%、-15.2±5.5%)術后左心室應變小于術前,由術后VP模式程控為VS模式后,左心室應變變大(P0.05);VS組(-16.3±3.2%、-15.2±5.5%、-12.8±3.1%)術后數據小于術前,由術后VS模式程控為VP模式后,左心室應變變小(P0.05)。組間比較,VP組、VP-VS組及VS組間差異無統(tǒng)計學意義(P0.05)。余Tp-Te間期、R波高度、LVDs、LVEDd、LVEF%、A-VTI、A、A/E、左室左心室收縮期應變率(SRs)、左心室舒張早期應變率(SRe)、左心房收縮期應變率(SRa)組內、組間差異均無統(tǒng)計學意義(P0.05)。結論:1雙腔起搏器心室不同部位植入的患者,術后1周,與中下位、低位、心尖部起搏相比,中位間隔起搏的心電圖QRS波寬度最窄。2心室不同起搏比例(VP組、VP-VS組、VS組)的患者,術后1周測量心臟結構相關指標(左室收縮末直徑、左室舒張末直徑),組內、組間都無顯著差異。3即刻改變起搏模式,由心室起搏程控為心室感知,左心室應變增大;由心室感知程控為心室起搏,左心室應變減小。
[Abstract]:Objective: combined with ECG and two-dimensional speckle tracking imaging, compared with dual chamber pacemaker implantation site of ventricular electrodes with different electrocardiographic characteristics and ventricular pacing on cardiac function in the immediate effect. Methods: the patients were divided into groups and prospective review group, review groups including sick sinus syndrome, dual chamber pacemaker implantation in patients with atrioventricular block and both, (n=131), according to the medical records of surgical implantation sites were divided into 4 groups: the median interval group, lower interval group, low interval group, apex group. Prospective patients including sick sinus syndrome, dual chamber pacemaker implantation in patients with atrioventricular block and both, (n=85). According to the percentage of ventricular pacing after operation were divided into 3 groups: VP group (pacing percentage = 90%), group VP-VS (aged 80% and 90% pacing percentage), VS group (pacing proportion 80%). Review group according to the 12 lead ECG before and after the operation record Figure, measuring QRS wave duration, Tp-Te interval and R wave height. The prospective group of patients before and after 1 weeks measured BNP, recording 12 lead electrocardiogram measurement of QRS wave duration, Tp-Te interval and R wave height, preoperative, postoperative 1 weeks and 1 weeks after the operation of programmed pacing mode (after 2 minutes after 1 weeks of recording pacemaker pacing mode for ventricular pacing, A-V pacemaker prolonged delay interval, if possible, the patients with ventricular pacing pacing mode by adjusting ventricular perception; if ventricular pacemaker sensing, appropriate to shorten the A-V delay interval, patients from the ventricular pacing mode for ventricular pacing, sensing adjustment) the heart by two-dimensional ultrasound speckle tracking technique to observe the indexes of left ventricular function: left ventricular end systolic diameter (left ventricular end-systolic dimension, LVDs), left ventricular end diastolic diameter (left ventricular end-diastolic dimension, LVEDd), left ventricular ejection fraction (Le ft ventricular ejection fraction,LVEF),A宄，

本文編號：1540744