摘要
目的 :观察双腔起搏器 (DDD)不同房室延迟间期 (AVD)及 VVI起搏时的血流动力学及左心功能变化。 方法 :完全性房室传导阻滞植入 DDD永久人工起搏器患者 19例 ,男 10例 ,女 9例 ,年龄 (6 6 .79± 15 .5 2 )岁 ,采用彩色多普勒超声心动图测量DDD起搏时不同 AVD及 VVI起搏时二尖瓣前向血流图 (E、A峰 ) ,主动脉前向血流速度 (AFV)及速度时间积分 (AFVTI)、左心室收缩 /舒张末期内径 (L VESd/ L VEDd)、左室射血分数 (L VEF)、每搏输出量 (SV)、心排血量 (CO)等。预设心房起搏频率为 75次/ min,AVD自 90 ms以 30 m s步长依次递增至 2 4 0 ms,最后程控为 VVI模式。结果 :(1) DDD起搏时血流动力学各参数随 AVD变化而变化 ,当 AVD为 (16 3.30± 30 .4 1) ms时 ,E、A峰 ,AFV,AFVTI达最大 ;当 AVD为 2 4 0 ms时 ,部分患者 E、A峰融合呈单峰 ;当以 VVI起搏时 ,E峰高低不等 ,A峰间断、不规则出现 ,AFV、AFVTI较 DDD起搏时明显减小。 (2 ) DDD起搏时心功能各参数随 AVD的递增而改善 ,达峰值后又逐渐下降 ;AVD为 (16 3.30± 30 .4 1) ms时 ,CO达最大 [(6 .5 0± 1.5 4 ) L / m in],较 AVD为 90 ms [(5 . 83± 1. 6 1) L / min ]、 2 4 0 ms [(5 . 85± 1. 2 8) L / min ]时分别增加 11. 5 %、 11. 1% ,较
Objective:To study the left cardiac function and hemodynamics during different atrioventricular delay with DDD pacemaker and VVI mode pacemaker.Methods: Nineteen patients with complete A V block [aged (66.79±15.52) years] with DDD pacemakers were studied. Cardiac output(CO), stroke volume (SV), aortic flow velocity (AFV), aortic flow velocity time integral (AFVTI), mitral blood stream (E,A peak), left ventricular end systolic diameter (LVESd), left ventricular end diastolic diameter (LVEDd) during different AVD and VVI mode were measured by Doppler echocardiography. The atrium pacing rate was set at 75 beats per minute. The AVD was prolonged to 240 ms stepwise by 30 ms starting from 90 ms and at last pacing in VVI mode. Results: (1) As AVD was prolonged, and E, A peaks, AFV, AFVTI were gradually increasing to maximum and then decreased. When AVD was at (163.30±30.41) ms, E, A peaks, AFV and AFVTI was at maximal. When AVD was at 240 ms,A peaks disappeared in 2 patients. At VVI mode,A peaks appeared intermittently and irregularly; AFV, AFVTI was significantly lower than at DDD mode. (2) Cardiac function changed with different AVD. When AVD was (163.30±30.41) ms, CO was maximal [(6.50±1.54) L/min], which was greater (by 11.5% and 11.1%) than that at AVD 90 ms [(5.83±1.61) L/min] and AVD 240 ms [(5.85±1.28) L/min], and was greater (by 25.9%) than that at VVI mode [(4.83±0.80) L/min]. Conclusion: At DDD mode, Cardiac function and hemodynamics are better than that at VVI mode and changed with different AVD. Cardiac function parameters are at maximal,only in certain AVD range. AVD optimization is as important as choice of pacing mode in patients with A V block and cardiac dysfunction.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2003年第8期865-867,共3页
Academic Journal of Second Military Medical University
基金
国家自然科学基金 ( 3 0 2 70 5 65 )
