右室不同部位起搏对左室收缩同步性及整体收缩功能早期影响的实时三维超声心动图研究
发布时间：2018-10-23 12:19
【摘要】：背景右室心尖部由于肌小梁丰富，起搏器电极易放置，脱位率低，故长期以来临床上通常选择右室心尖部起搏作为永久心脏起搏器的植入部位。但近年来，国内外相关研究表明，长期的右室心尖部起搏可导致心室肌电-机械活动的异常，从而影响心肌收缩同步性及心功能。右室流出道起搏是近几年应用于临床的一项新的起搏技术，因其起搏位点更接近正常心脏传导路径，理论上可获得更生理的心肌传导顺序而备受关注。不同部位起搏对左室收缩同步性及心功能的早期影响还有待进一步的研究，实时三维超声心动图作为近年来应用于临床的一项超声新技术，可在同一心动周期同时比较左室壁16节段的收缩同步性及心功能。 目的探讨应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价右室不同部位起搏对左室收缩同步性及整体收缩功能的早期影响。方法60例房室顺序双心腔起搏、感知触发和抑制型（dual-chamber demand, DDD）起搏器植入的患者，根据起搏部位不同分为右室流出道（right ventricular outflow tract,RVOT）组及右室心尖（right ventricular apex pacing, RVAP)组。两组患者均于术前及术后1周应用RT-3DE采集左心室全容积图像并应用在机Qlab8.1分析软件，获得左心室整体与16节段容积-时间曲线和左心室16节段（包括6个基底段6个中间段和4个心尖段）、12节段（包括6个基底段和6个中间段）、6节段（6个基底段）自心电图QRS波起点至左心室最小收缩末容积点时间的标准差和最大时间差(即Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)作为左室收缩同步性参数；同时获得左心室舒张末期容积(1eft ventricle end-diastolic volume, LVEDV)、左心室收缩末期容积(1eft ventricular end-systolic volumes, LVESV)、每搏量(stroke volume, SV)、左心室射血分数(1eft ventricular ejection fraction, LVEF)作为左室整体收缩功能参数。将上述左室同步性参数及整体收缩功能参数进行组内术前术后比较及组间同期比较。 结果1. RVAP组与RVOT组在年龄、性别、心率、左室射血分数方面差异无统计学意义（p0.05）。2.术前RVAP组与RVOT组在左室同步性参数及左室整体收缩功能参数方面比较均无统计学差异（p0.05）。术后一周，RVAP组左室收缩同步性参数(即Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)与术前比较明显延长（P0.05），与RVOT组同期比较亦明显延长（P0.05），RVOT组左室同步性参数术后与术前比较无统计学差异（p0.05）。3.左室整体收缩功能参数(LVEDV、LVESV、SV、LVEF)在RVAP组与RVOT组组内术前术后比较及术后组间比较均无统计学差异（p0.05）。 结论1.RVAP早期就可导致左室收缩同步性下降，，与RVAP起搏比较，RVOT起搏更有利于起搏状态下左室同步性收缩，是一种更符合生理的起搏方式。2.RVOT起搏与RVAP在起搏早期均未影响左室整体收缩功能。3.RT-3DE可客观、准确地评价左室收缩同步性及整体收缩功能。
[Abstract]:Background due to the rich trabeculae, easy placement of pacemaker electrodes and low dislocation rate, the right ventricular apex pacing is usually chosen as the implantation site of permanent cardiac pacemakers in clinic for a long time. However, in recent years, studies at home and abroad have shown that long-term right ventricular apex pacing can lead to abnormal electromyography and mechanical activity of the ventricle, thus affecting the synchronism of myocardial contraction and cardiac function. Right ventricular outflow tract pacing (RVOT) is a new pacing technique applied in clinic in recent years. It has attracted much attention because its pacing site is closer to normal cardiac conduction pathway and more physiological cardiac conduction sequence can be obtained theoretically. The effects of different pacing sites on left ventricular systolic synchrony and cardiac function need to be further studied. Real-time three-dimensional echocardiography is a new ultrasound technique applied in clinic in recent years. Systolic synchrony and cardiac function of 16 segments of left ventricular wall can be compared simultaneously in the same cardiac cycle. Objective to evaluate the early effects of different right ventricular pacing on left ventricular systolic synchrony and global systolic function by real time three dimensional echocardiography (real-time three-dimensional echocardiography,RT-3DE). Methods Sixty patients with atrioventricular sequential biventricular pacing, perceptual trigger and inhibition (dual-chamber demand, DDD) pacemaker implantation) were divided into right ventricular outflow tract (right ventricular outflow tract,RVOT) group and right ventricular apex (right ventricular apex pacing, RVAP) group according to the location of pacing. The left ventricular full volume images were collected by RT-3DE before operation and 1 week after operation, and the Qlab8.1 analysis software was used in both groups. The left ventricular global and 16 segmental volume-time curves and left ventricular 16 segments (including 6 basal segments, 6 intermediate segments and 4 apical segments), 12 segments (including 6 basal segments and 6 middle segments), 6 segments (6 basal segments), and 6 segments (6 basal segments) were obtained. The standard deviation and maximum time difference (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) from the beginning of QRS wave to the minimum end-systolic volume point of left ventricle (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) were used as the synchronization parameters of left ventricle. At the same time, left ventricular end-diastolic volume (1eft ventricle end-diastolic volume, LVEDV),) left ventricular end-systolic volume (1eft ventricular end-systolic volumes, LVESV), volume per stroke) (stroke volume, SV), left ventricular ejection fraction (1eft ventricular ejection fraction, LVEF) was obtained as a parameter of global left ventricular systolic function. The parameters of left ventricular synchrony and global systolic function were compared before and after operation and at the same time. Result 1. There was no significant difference in age, sex, heart rate and left ventricular ejection fraction between RVAP group and RVOT group (p0.05). There was no significant difference between RVAP group and RVOT group in the parameters of left ventricular synchronism and left ventricular global systolic function (p0.05). One week after operation, the left ventricular systolic synchronism (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) in RVAP group was significantly longer than that in preoperative group (P0.05), and that in RVOT group was significantly longer than that in RVOT group (P0.05). There was no significant difference between), RVOT group and pre-operation group (p0.05). There was no significant difference in left ventricular global systolic function (LVEDV,LVESV,SV,LVEF) between RVAP group and RVOT group before and after operation (p0.05). Conclusion compared with RVAP pacing, RVOT pacing is more beneficial to the synchronous contraction of left ventricle in the early stage of 1.RVAP. 2.RVOT pacing and RVAP pacing did not affect the global left ventricular systolic function in the early stage of pacing. 3.RT-3DE can objectively and accurately evaluate the left ventricular systolic synchrony and global systolic function.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45
本文编号：2289214
[Abstract]:Background due to the rich trabeculae, easy placement of pacemaker electrodes and low dislocation rate, the right ventricular apex pacing is usually chosen as the implantation site of permanent cardiac pacemakers in clinic for a long time. However, in recent years, studies at home and abroad have shown that long-term right ventricular apex pacing can lead to abnormal electromyography and mechanical activity of the ventricle, thus affecting the synchronism of myocardial contraction and cardiac function. Right ventricular outflow tract pacing (RVOT) is a new pacing technique applied in clinic in recent years. It has attracted much attention because its pacing site is closer to normal cardiac conduction pathway and more physiological cardiac conduction sequence can be obtained theoretically. The effects of different pacing sites on left ventricular systolic synchrony and cardiac function need to be further studied. Real-time three-dimensional echocardiography is a new ultrasound technique applied in clinic in recent years. Systolic synchrony and cardiac function of 16 segments of left ventricular wall can be compared simultaneously in the same cardiac cycle. Objective to evaluate the early effects of different right ventricular pacing on left ventricular systolic synchrony and global systolic function by real time three dimensional echocardiography (real-time three-dimensional echocardiography,RT-3DE). Methods Sixty patients with atrioventricular sequential biventricular pacing, perceptual trigger and inhibition (dual-chamber demand, DDD) pacemaker implantation) were divided into right ventricular outflow tract (right ventricular outflow tract,RVOT) group and right ventricular apex (right ventricular apex pacing, RVAP) group according to the location of pacing. The left ventricular full volume images were collected by RT-3DE before operation and 1 week after operation, and the Qlab8.1 analysis software was used in both groups. The left ventricular global and 16 segmental volume-time curves and left ventricular 16 segments (including 6 basal segments, 6 intermediate segments and 4 apical segments), 12 segments (including 6 basal segments and 6 middle segments), 6 segments (6 basal segments), and 6 segments (6 basal segments) were obtained. The standard deviation and maximum time difference (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) from the beginning of QRS wave to the minimum end-systolic volume point of left ventricle (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) were used as the synchronization parameters of left ventricle. At the same time, left ventricular end-diastolic volume (1eft ventricle end-diastolic volume, LVEDV),) left ventricular end-systolic volume (1eft ventricular end-systolic volumes, LVESV), volume per stroke) (stroke volume, SV), left ventricular ejection fraction (1eft ventricular ejection fraction, LVEF) was obtained as a parameter of global left ventricular systolic function. The parameters of left ventricular synchrony and global systolic function were compared before and after operation and at the same time. Result 1. There was no significant difference in age, sex, heart rate and left ventricular ejection fraction between RVAP group and RVOT group (p0.05). There was no significant difference between RVAP group and RVOT group in the parameters of left ventricular synchronism and left ventricular global systolic function (p0.05). One week after operation, the left ventricular systolic synchronism (Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif,Tmsv12-Dif,Tmsv6-Dif) in RVAP group was significantly longer than that in preoperative group (P0.05), and that in RVOT group was significantly longer than that in RVOT group (P0.05). There was no significant difference between), RVOT group and pre-operation group (p0.05). There was no significant difference in left ventricular global systolic function (LVEDV,LVESV,SV,LVEF) between RVAP group and RVOT group before and after operation (p0.05). Conclusion compared with RVAP pacing, RVOT pacing is more beneficial to the synchronous contraction of left ventricle in the early stage of 1.RVAP. 2.RVOT pacing and RVAP pacing did not affect the global left ventricular systolic function in the early stage of pacing. 3.RT-3DE can objectively and accurately evaluate the left ventricular systolic synchrony and global systolic function.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R540.45
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