摘要
目的 :人工心脏起搏后的血液动力学状态是提高病人生活质量的关键。本文采用超声心动图研究了心脏起搏前、后的血液动力学变化 ,以评价不同起搏方式的血液动力学效应。方法 :对 32例植入人工心脏起搏器的病人 ,采用M型、二维及多普勒超声心动图检测了心室按需起搏 (VVI)不伴室房逆传 (A1组 )和伴室房逆传 (A2组 )及房室顺序起搏 (DDD) (B组 )的左心结构、左室的泵血功能、左室收缩及舒张功能指标。结果 :1、A1组与B组起搏后的心输出量 (CO)明显增加 (P <0 0 5 ) ,A2 组则CO增加不明显 (P >0 0 5 )。心搏量 (SV)各组均呈下降的趋势 ,A2 组下降更为明显。但起搏后三组间比较无显著性差异 (P >0 0 5 )。 2、A1组的收缩及舒张功能均有受损 ,B组主要损害左室的舒张功能 ,对左室的收缩功能影响不明显。 3、A2 组起搏后血液动力学效应在三组间最差。结论 :无论心室起搏 (VP)还是房室顺序起搏 (AVP)起搏后由于心率的增加均可使CO增加 ,但对左室的功能均有不同程度的损害 ,VP伴室房逆传者最为明显 ,VP不伴室房逆传者次之 ,AVP损害程度三组间最轻。因此 ,AVP也并非真正的生理性起搏器。临床上提倡埋植更接近生理状态的起搏器 (多部位心脏起搏 ) ,以保持良好的心功能状态。
Objective:Hemodynamic effects of artificial cardiac pacing is the key which improves the quality of life in patients with pacing.To evaluate the hemodynamic effects of different pacing mode,we studied changes of hemodynamics before and after the cardiac pacing.Methods:Left ventricular structrure,left ventricular pumping function,systolic function and diastolic function of left ventricule were studied by M mode,2-dimensional and Doppler echocardiaography in 32 patients treated by ventricular pacing(VP) with and without ventriculoatrial conduction and atrioventricular sequential pacing(AVP).Results:1.Cardiac output(CO) of pacing rhythm was significantly high compared with CO of spontaneous rhythm in group of VP without ventriculoatrial conduction and AVP(P<0 05),but it was not with the group of VP with ventriculoatrial conduction (P>0 05)。Stroke volume (SV)showed a decreased tendency in all groups.this tendency was the most obvious in the group of VP with ventriculoatrial conduction.And after pacing (P>0 05).2.The systolic and diastolic function of the left ventricule was damaged in VP group,but in AVP group the distolic function of left ventricule was only damaged and the systolic function of left ventricule had obviously changes.3.Hemodynamic effects of VP with ventriculoatrial conduction group was the worst in all groups. Conclusion: CO had been raised by increased heart rate in all groups,but the left ventricular function was damaged in different degree.The degree of damage is the most serious in the group of VP with ventriculoatrial conduction,is slighter in the group of VP without ventriculoatrial conduction and is the slightest in the group of AVP. Therefore atrioventricular sequential pacemaker is not real physiological pacemaker.We suggest that the more closer physilogical status pacemaker(multisite cardiac pacing)should be implanted in patients with bradycardias keeping well cardiac function.
出处
《内蒙古医学院学报》
2001年第1期29-34,共6页
Acta Academiae Medicinae Neimongol
