本文關(guān)鍵詞： 心室起搏 斑點(diǎn)追蹤 即時(shí)影響 心室功能 應(yīng)變 應(yīng)變率　出處：《河北醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:結(jié)合心電圖及二維斑點(diǎn)追蹤顯像技術(shù),比較雙腔起搏器心室電極不同植入部位對(duì)心電圖特點(diǎn)及心室起搏對(duì)心臟功能的即時(shí)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(jié)綜合征、房室傳導(dǎo)阻滯及兩者均有在內(nèi)的雙腔起搏器植入患者(n=131),按病歷記錄手術(shù)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(jié)綜合征、房室傳導(dǎo)阻滯及兩者均有在內(nèi)的雙腔起搏器植入患者(n=85),按術(shù)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%)�；仡櫧M根據(jù)術(shù)前及術(shù)后記錄的12導(dǎo)聯(lián)體表心電圖,測量QRS波時(shí)限、Tp-Te間期及R波高度。前瞻組患者術(shù)前、術(shù)后1周測量BNP,記錄12導(dǎo)聯(lián)體表心電圖測量QRS波時(shí)限、Tp-Te間期及R波高度,術(shù)前、術(shù)后1周及術(shù)后1周程控調(diào)節(jié)起搏模式2分鐘后(術(shù)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(dāng)延長A-V delay間期,如可能,將患者起搏模式由心室起搏調(diào)整為心室感知;若為心室感知,起搏器程控適當(dāng)縮短A-V delay間期,將患者起搏模式由心室感知調(diào)整為心室起搏),采用心臟超聲二維斑點(diǎn)追蹤技術(shù)觀察左心功能指標(biāo):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?jǐn)?shù)(Left ventricular ejection fraction,LVEF)、A峰、E/A值、A峰血流速度時(shí)間積分(A peak velocity time integral,A-VTI)、左心室應(yīng)變(Strain,S)、左心室應(yīng)變率(Strain rate,SR)。數(shù)據(jù)應(yīng)用SPSS20.0統(tǒng)計(jì)軟件,計(jì)量資料經(jīng)檢驗(yàn)符合正態(tài)性分布和方差齊性時(shí),采用均數(shù)±標(biāo)準(zhǔn)差(?x±s)表示,組內(nèi)比較用配對(duì)t檢驗(yàn),回顧組組間比較用獨(dú)立樣本t檢驗(yàn),前瞻組組間比較采用重復(fù)測量方差分析,認(rèn)為P0.05有統(tǒng)計(jì)學(xué)差異。結(jié)果:1回顧組:組內(nèi)比較,中位間隔、中下隔、低位間隔、心尖組QRS波寬度術(shù)后均較術(shù)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(shù)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(jì)學(xué)意義(P0.05)。余Tp-Te間期、R波高度組內(nèi)、組間比較差異均無明顯統(tǒng)計(jì)學(xué)意義(P0.05);2前瞻組:QRS波組內(nèi)比較,VP組、VP-VS組、VS組術(shù)后QRS波寬度均較術(shù)前增寬(94±11ms to 146±62ms;102±31ms to133±38ms;82±27ms to 125±34ms),差異有統(tǒng)計(jì)學(xué)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(jì)學(xué)意義(P0.05)。BNP組內(nèi)比較,VP組、VP-VS組、VS組BNP術(shù)后較術(shù)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(jì)學(xué)意義(P0.05)。組間比較無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。左心室應(yīng)變(S)組內(nèi)比較,VP、VP-VS、VS組術(shù)前、術(shù)后1周及術(shù)后程控左心室應(yīng)變差異有統(tǒng)計(jì)學(xué)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(shù)后左心室應(yīng)變小于術(shù)前,由術(shù)后VP模式程控為VS模式后,左心室應(yīng)變變大(P0.05);VS組(-16.3±3.2%、-15.2±5.5%、-12.8±3.1%)術(shù)后數(shù)據(jù)小于術(shù)前,由術(shù)后VS模式程控為VP模式后,左心室應(yīng)變變小(P0.05)。組間比較,VP組、VP-VS組及VS組間差異無統(tǒng)計(jì)學(xué)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(yīng)變率(SRs)、左心室舒張?jiān)缙趹?yīng)變率(SRe)、左心房收縮期應(yīng)變率(SRa)組內(nèi)、組間差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1雙腔起搏器心室不同部位植入的患者,術(shù)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(shù)后1周測量心臟結(jié)構(gòu)相關(guān)指標(biāo)(左室收縮末直徑、左室舒張末直徑),組內(nèi)、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(yīng)變增大;由心室感知程控為心室起搏,左心室應(yīng)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(hào)：1540744