双腔起搏器心室电极不同植入部位心电图特点以及心室起搏对心脏功能的即时影响

发布时间：2018-02-27 02:28

  本文关键词： 心室起搏 斑点追踪 即时影响 心室功能 应变 应变率　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:结合心电图及二维斑点追踪显像技术,比较双腔起搏器心室电极不同植入部位对心电图特点及心室起搏对心脏功能的即时影响。方法:将病人分为回顾组及前瞻组,回顾组患者为包括病态窦房结综合征、房室传导阻滞及两者均有在内的双腔起搏器植入患者(n=131),按病历记录手术植入部位分为4组:中位间隔组、中下间隔组、低位间隔组、心尖组。前瞻组患者为包括病态窦房结综合征、房室传导阻滞及两者均有在内的双腔起搏器植入患者(n=85),按术后心室起搏比例分为3组:VP组(起搏比例≥90%)、VP-VS组(起搏比例≥80%且90%)、VS组(起搏比例80%)。回顾组根据术前及术后记录的12导联体表心电图,测量QRS波时限、Tp-Te间期及R波高度。前瞻组患者术前、术后1周测量BNP,记录12导联体表心电图测量QRS波时限、Tp-Te间期及R波高度,术前、术后1周及术后1周程控调节起搏模式2分钟后(术后1周起搏器程控记录起搏模式,若为心室起搏,起搏器程控适当延长A-V delay间期,如可能,将患者起搏模式由心室起搏调整为心室感知;若为心室感知,起搏器程控适当缩短A-V delay间期,将患者起搏模式由心室感知调整为心室起搏),采用心脏超声二维斑点追踪技术观察左心功能指标:左室收缩末直径(left ventricular end-systolic dimension,LVDs)、左室舒张末直径(left ventricular end-diastolic dimension,LVEDd)、左室射血分数(Left ventricular ejection fraction,LVEF)、A峰、E/A值、A峰血流速度时间积分(A peak velocity time integral,A-VTI)、左心室应变(Strain,S)、左心室应变率(Strain rate,SR)。数据应用SPSS20.0统计软件,计量资料经检验符合正态性分布和方差齐性时,采用均数±标准差(?x±s)表示,组内比较用配对t检验,回顾组组间比较用独立样本t检验,前瞻组组间比较采用重复测量方差分析,认为P0.05有统计学差异。结果:1回顾组:组内比较,中位间隔、中下隔、低位间隔、心尖组QRS波宽度术后均较术前增宽(104±27ms to 125±40 ms;103±22 ms to 139±26 ms;97±34 ms to 164±24 ms;64±35 ms to 171±57 ms)(P0.05);组间比较,术后中位间隔组QRS波宽度最短,与其他3组比较差异有统计学意义(P0.05)。余Tp-Te间期、R波高度组内、组间比较差异均无明显统计学意义(P0.05);2前瞻组:QRS波组内比较,VP组、VP-VS组、VS组术后QRS波宽度均较术前增宽(94±11ms to 146±62ms;102±31ms to133±38ms;82±27ms to 125±34ms),差异有统计学意义(P0.05);组间比较,VP组、VP-VS组、VS组之间差异无明显统计学意义(P0.05)。BNP组内比较,VP组、VP-VS组、VS组BNP术后较术前相比明显下降(181±36pg/ml to 95±20pg/ml;201±69pg/ml to 102±47pg/ml;177±10pg/ml to 58±34pg/ml),差异有统计学意义(P0.05)。组间比较无明显统计学差异(P0.05)。左心室应变(S)组内比较,VP、VP-VS、VS组术前、术后1周及术后程控左心室应变差异有统计学意义(P0.05),其中VP组(-19.0±0.9%、-13.6±4.5%、-15.4±4.4%)、VP-VS组(-21.0±5.2%、13.3±5.6%、-15.2±5.5%)术后左心室应变小于术前,由术后VP模式程控为VS模式后,左心室应变变大(P0.05);VS组(-16.3±3.2%、-15.2±5.5%、-12.8±3.1%)术后数据小于术前,由术后VS模式程控为VP模式后,左心室应变变小(P0.05)。组间比较,VP组、VP-VS组及VS组间差异无统计学意义(P0.05)。余Tp-Te间期、R波高度、LVDs、LVEDd、LVEF%、A-VTI、A、A/E、左室左心室收缩期应变率(SRs)、左心室舒张早期应变率(SRe)、左心房收缩期应变率(SRa)组内、组间差异均无统计学意义(P0.05)。结论:1双腔起搏器心室不同部位植入的患者,术后1周,与中下位、低位、心尖部起搏相比,中位间隔起搏的心电图QRS波宽度最窄。2心室不同起搏比例(VP组、VP-VS组、VS组)的患者,术后1周测量心脏结构相关指标(左室收缩末直径、左室舒张末直径),组内、组间都无显著差异。3即刻改变起搏模式,由心室起搏程控为心室感知,左心室应变增大;由心室感知程控为心室起搏,左心室应变减小。
[Abstract]:Objective: combined with ECG and two-dimensional speckle tracking imaging, compared with dual chamber pacemaker implantation site of ventricular electrodes with different electrocardiographic characteristics and ventricular pacing on cardiac function in the immediate effect. Methods: the patients were divided into groups and prospective review group, review groups including sick sinus syndrome, dual chamber pacemaker implantation in patients with atrioventricular block and both, (n=131), according to the medical records of surgical implantation sites were divided into 4 groups: the median interval group, lower interval group, low interval group, apex group. Prospective patients including sick sinus syndrome, dual chamber pacemaker implantation in patients with atrioventricular block and both, (n=85). According to the percentage of ventricular pacing after operation were divided into 3 groups: VP group (pacing percentage = 90%), group VP-VS (aged 80% and 90% pacing percentage), VS group (pacing proportion 80%). Review group according to the 12 lead ECG before and after the operation record Figure, measuring QRS wave duration, Tp-Te interval and R wave height. The prospective group of patients before and after 1 weeks measured BNP, recording 12 lead electrocardiogram measurement of QRS wave duration, Tp-Te interval and R wave height, preoperative, postoperative 1 weeks and 1 weeks after the operation of programmed pacing mode (after 2 minutes after 1 weeks of recording pacemaker pacing mode for ventricular pacing, A-V pacemaker prolonged delay interval, if possible, the patients with ventricular pacing pacing mode by adjusting ventricular perception; if ventricular pacemaker sensing, appropriate to shorten the A-V delay interval, patients from the ventricular pacing mode for ventricular pacing, sensing adjustment) the heart by two-dimensional ultrasound speckle tracking technique to observe the indexes of left ventricular function: left ventricular end systolic diameter (left ventricular end-systolic dimension, LVDs), left ventricular end diastolic diameter (left ventricular end-diastolic dimension, LVEDd), left ventricular ejection fraction (Le ft ventricular ejection fraction,LVEF),A宄，

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