本文選題：右心室流出道間隔部　切入點(diǎn)：右心室心尖部　出處：《新疆醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討右心室流出道間隔部起搏和右心室心尖部起搏的長(zhǎng)期臨床療效及安全性。方法：選擇2007年2月—2013年12月在新疆醫(yī)科大學(xué)第一附屬醫(yī)院確診的嚴(yán)重緩慢型心律失�；颊�1001例。根據(jù)心室電極固定部位分為RVOTS組(521例)和RVA組(480例)。比較兩組患者起搏器植入術(shù)后即刻、術(shù)后1w及術(shù)后1、6、12、18、24個(gè)月心室起搏電極相關(guān)的基本參數(shù),術(shù)前、術(shù)后12、24月心臟彩超參數(shù)以及手術(shù)并發(fā)癥。結(jié)果：RVOTS組術(shù)后即刻起搏閾值[(0.77±0.28)V]較RVA組[(0.53±0.17)V]高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組在術(shù)后1w及術(shù)后1、6、12、18、24個(gè)月起搏閡值差異無統(tǒng)計(jì)學(xué)意義(P0.05),兩組感知及阻抗在不同時(shí)點(diǎn)的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組起搏參數(shù)均在可接受范圍內(nèi)且長(zhǎng)期保持穩(wěn)定。RVOTS組曝光時(shí)間[(18.76±7.3)min]較RVA組[(9.66士7.16)min]長(zhǎng),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后12月RVA組LAD、LVEDD及LVESD較RVOTS組均增大,LVEF降低,但除外LVESD差異有統(tǒng)計(jì)學(xué)意義外,其余均無相關(guān)統(tǒng)計(jì)學(xué)意義。與RVOTS組相比,術(shù)后24月RVA組LAD、LVEDD及LVESD進(jìn)一步增大,LVEF明顯降低,差異均具有統(tǒng)計(jì)學(xué)意義。RVA組無心臟穿孔,RVOTS組發(fā)生7例,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：RVOTS起搏是可行的,長(zhǎng)期隨訪起搏參數(shù)穩(wěn)定。但是當(dāng)主動(dòng)螺旋電極固定于RVOTS并指向前壁或游離壁可能增加心臟穿孔風(fēng)險(xiǎn)。
[Abstract]:Objective: to investigate the long-term clinical efficacy and safety of right ventricular outflow tract septum pacing and right ventricular apical pacing. Methods: select the severe and slow diagnosis of right ventricular outflow tract septum pacing and right ventricular apical pacing in the first affiliated Hospital of Xinjiang Medical University from February 2007 to December 2013. One hundred and one hundred and one patients with cardiac arrhythmia were divided into RVOTS group (n = 521) and RVA group (n = 480) according to the fixed position of ventricular electrode. The basic parameters related to ventricular pacing electrodes at 1 week after operation and 1 month 1, 12 and 24 months after operation, cardiac color Doppler parameters before, 12 and 24 months after operation, and surgical complications. Results the threshold of immediate pacing in the RVA group [0.77 鹵0.28 V] was higher than that in the RVA group [0.53 鹵0.17V]. There was no significant difference in pacemaker threshold between the two groups at 1 week after operation and 1 month after operation (P 0.05). There was no significant difference in perception and impedance between the two groups at different time points (P 0.05). The pacing parameters of the two groups were in the acceptable range. The exposure time of RVOTS group [18.76 鹵7.3 min] was longer than that of RVA group [9.66 鹵7.16 min]. On December after operation, LVEDD and LVESD in RVA group were larger and lower than those in RVOTS group, but the rest had no statistical significance except the difference of LVESD. Compared with RVOTS group, LVEDD and LVESD in RVA group were significantly higher than those in RVOTS group on December. LVEDD and LVESD in RVA group decreased significantly 24 months after operation. There were 7 cases in RVOTS group without cardiac perforation, and the difference was statistically significant (P 0.05). Conclusion\% RVOTS pacing is feasible. Long-term follow-up pacing parameters are stable, but when the active spiral electrode is fixed to the RVOTS and points to the anterior or free wall, it may increase the risk of cardiac perforation.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.7

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