本文選題：右心室間隔部起搏　切入點(diǎn)：起搏　出處：《南京大學(xué)》2015年碩士論文

【摘要】：目的：通過對(duì)比分析右室間隔不同部位起搏時(shí)的QRS波形態(tài)、QRS波間期及心室收縮同步性等指標(biāo)的差異,總結(jié)具體間隔部何處起搏時(shí)效果更優(yōu),進(jìn)而指導(dǎo)右室導(dǎo)線植入部位的選擇。方法：入選2014年6月至2015年3月期間在鼓樓醫(yī)院心內(nèi)科因房室傳導(dǎo)阻滯需植入永久起搏器的患者。術(shù)前收集其臨床基本情況及心電圖資料,術(shù)中記錄起搏參數(shù),術(shù)后所有患者在心室完全起搏的情況下行標(biāo)準(zhǔn)12導(dǎo)聯(lián)心電圖及心臟彩超檢查,測量記錄起搏心電圖QRS間期(PQRSd),Ⅰ、Ⅲ導(dǎo)聯(lián)QRS波主波方向,胸導(dǎo)聯(lián)發(fā)生移行的導(dǎo)聯(lián),以及心室間(IVMD)和心室內(nèi)收縮同步性指標(biāo)(SPWMD、 Tmsv16-SD、SDI,其中Tmsv16-SD和SDI由三維心臟彩超獲得)。并使用心臟彩超對(duì)右室間隔部起搏導(dǎo)線精確定位,依據(jù)定位結(jié)果,分組分析各組間起搏參數(shù)、起搏心電圖形態(tài)特點(diǎn)、QRS間期、心室收縮同步性等指標(biāo)的差異。結(jié)果：共入選患者30例,其中25例患者完成資料收集,依據(jù)心臟彩超定位結(jié)果,將25例患者分為流入道間隔組與流出道間隔組,并依據(jù)定位結(jié)果將流入道間隔組進(jìn)一步分為間隔近心尖部組與間隔中下部組。研究發(fā)現(xiàn)：1、流入道間隔起搏與流出道間隔起搏時(shí)均可獲得穩(wěn)定的起搏參數(shù),且起搏閾值、感知、阻抗等參數(shù)間并無明顯差異；2、流入道間隔部起搏組與流出道間隔起搏組相比,前者PQRSd稍寬,差異無統(tǒng)計(jì)學(xué)意義(150.3±14.Oms VS 147.8±8.7ms;P=0.614);PQRSd于流入道間隔中下部起搏時(shí)最窄,且相比間隔近心尖部起搏時(shí)差異具有統(tǒng)計(jì)學(xué)意義(141.67±9.5ms VS 156.75±13.7ms;P=0.040);3、流入道間隔部起搏組與流出道間隔起搏組相比,心電圖Ⅲ導(dǎo)聯(lián)主波方向及移行導(dǎo)聯(lián)存在差異(P值分別為0.037及0.012),且Ⅲ導(dǎo)聯(lián)主波正向?qū)α鞒龅篱g隔部起搏有預(yù)測價(jià)值(AUC=0.776,P=0.02)；而間隔近心尖部起搏時(shí),Ⅲ導(dǎo)聯(lián)QRS波主波多為負(fù)向或等電位線,胸導(dǎo)聯(lián)多在V6或之后出現(xiàn)移行,Ⅲ導(dǎo)聯(lián)主波方向及移行導(dǎo)聯(lián)對(duì)右室導(dǎo)線位于間隔近心尖部有預(yù)測價(jià)值(AUC分別為0.849及0.908,P值均小于0.05)。4、心室機(jī)械收縮同步性方面,IVMD、SPWMD、Tmsv16-SD、SDI等指標(biāo)相比,流入道間隔部起搏組優(yōu)于流出道間隔部起搏組,且SPWMD、Tmsv16-SD、SDI等指標(biāo)差異存在顯著性,尤以SPWMD差異最明顯(P=0.007),且上述指標(biāo)在流入道間隔中下部起搏時(shí)最小。5、PQRSd與左右心室間的同步性存在相關(guān)性,而與心室內(nèi)收縮同步性無明顯相關(guān)。結(jié)論：1、在植入右室間隔部導(dǎo)線時(shí),Ⅲ導(dǎo)聯(lián)主波方向及移行導(dǎo)聯(lián)對(duì)右室導(dǎo)線位于間隔近心尖部有預(yù)測價(jià)值,而由于間隔近心尖部起搏時(shí),PQRd較寬,長期該部位起搏可能對(duì)心功能造成有害影響,故在行右室間隔部起搏時(shí),除應(yīng)滿足W線影像標(biāo)準(zhǔn)外,Ⅲ導(dǎo)聯(lián)主波方向及胸導(dǎo)聯(lián)移行部位也是重要的參考標(biāo)準(zhǔn)。2、在急性期內(nèi),相比流出道間隔部起搏,流入道間隔部起搏時(shí)室間及室內(nèi)均可獲得較好的同步性,且以左室內(nèi)機(jī)械收縮同步性優(yōu)越性最明顯,故流入道間隔部是更優(yōu)的起搏位置選擇。3、流入道間隔中下部起搏時(shí),PQRSd最窄,并且該部位起搏時(shí)心室收縮同步性亦優(yōu)于流入道間隔近心尖部起搏及流出道起搏時(shí),故流入道間隔中下部是理想的心室間隔起搏位點(diǎn)。
[Abstract]:Objective: QRS wave morphology through the comparative analysis of different right ventricular pacing sites interval, and other indicators of the shrinkage difference synchronization of the QRS wave interval and ventricular septum, summarize the specific where pacing is better, and to guide the selection of the location of the right ventricular lead implantation. Methods: selected from June 2014 to March 2015 during the Gulou Hospital Department of Cardiology for atrioventricular block need permanent pacemaker implantation in patients before the surgery. The clinical situation and ECG data, pacing parameters were recorded after operation, all patients performed a standardized complete ventricular pacing in 12 lead ECG and echocardiography examination, measuring and recording the pacing ECG QRS interval (PQRSd), 1, QRS wave in lead III the main wave direction, leads the transitional lead, and inter ventricular systolic synchrony (IVMD) and ventricular index (SPWMD, Tmsv16-SD, SDI, Tmsv16-SD and SDI by 3D heart color Super). And the use of echocardiography for precise positioning of the right ventricular septal pacing leads, based on the positioning results, grouping analysis of pacing parameters between groups, pacing ECG morphological characteristics, QRS interval, ventricular systolic synchrony index difference. Results: there were 30 patients, 25 patients completed the data collection, according to cardiac ultrasound localization results, 25 patients were divided into inlet septal group and septum group, and based on the positioning results will flow into the septum were further divided into the lower interval near the apex group and the interval. The study found: 1, inlet septal pacing and outflow tract septal pacing can obtain stable pacing parameters the pacing threshold and impedance parameters, perception, there were no significant differences between the 2 groups; septum pacing, inflow and outflow tract septal pacing group compared to the former PQRSd slightly wider, the difference was not statistically significant (150.3 + 14.Oms VS 14 7.8 + 8.7ms; P=0.614; PQRSd) in the lower inlet septal pacing in the narrow, and compared with statistical significance between near apex pacing difference (141.67 + 9.5ms VS 156.75 + 13.7ms; P=0.040; 3), inflow tract septal pacing group and septum pacing group compared to the ECG wave in lead III the direction and the transitional lead difference (P = 0.037 and 0.012), and the main wave in lead III positive outflow septal pacing has predictive value (AUC=0.776, P=0.02); and the interval near apex pacing, QRS wave in lead III main wave is negative to the line or, more chest lead in V6 or after the migration of lead III main wave direction and migration leads to right ventricular lead in interval near the apex has predictive value (AUC = 0.849 and 0.908, P values were less than 0.05.4), ventricular systolic synchrony, IVMD, SPWMD, Tmsv16-SD, SDI compared with other indicators, inflow tract Septal pacing group is better than the outflow tract septal pacing group, and SPWMD, Tmsv16-SD, SDI and other indicators have significant differences, especially in SPWMD, the most obvious difference (P=0.007), and the index in the lower inlet septal pacing in the minimum.5, the synchronization of the PQRSd and between the left and right ventricular in correlation with ventricular in synchrony was found. Conclusion: 1, implanted in the right ventricular septum lead, lead III main wave direction and migration leads to right ventricular lead in interval near the apex have predictive value, but because of the distance between apex pacing, PQRd wide, the long-term pacing may cause harmful effects it is good to cardiac function, right ventricular septal pacing, should satisfy the W line image standard,.2 standard reference lead III main wave direction and the precordial transitional zone is also important, in the acute period, compared with RVOT pacing, inflow tract septum up Pre room and indoor can achieve good synchronization, and the mechanical advantage of left ventricular systolic synchronization is the most obvious, so the inflow tract septum pacing is better choice of the location of.3, into the lower tract pacing interval, PQRSd the most narrow, and the ventricular pacing when the systolic synchrony is also superior to the distance between apical pacing and outflow from stroke, so the inflow of lower tract interval ventricular septal pacing site is ideal.

【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 周燁;杜榮增;嚴(yán)金川;錢駿;吳駿;陳廣華;;右心室高位與中位室間隔部起搏的臨床對(duì)照研究[J];實(shí)用心電學(xué)雜志;2011年01期

2 宿燕崗;葛均波;;生理性起搏的再認(rèn)識(shí)[J];中國心臟起搏與心電生理雜志;2007年03期

，

本文編號(hào)：1729815