右心室不同部位起搏的长期疗效及安全性研究

发布时间：2018-03-09 09:25

本文选题：右心室流出道间隔部　切入点：右心室心尖部　出处：《新疆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨右心室流出道间隔部起搏和右心室心尖部起搏的长期临床疗效及安全性。方法：选择2007年2月—2013年12月在新疆医科大学第一附属医院确诊的严重缓慢型心律失常患者1001例。根据心室电极固定部位分为RVOTS组(521例)和RVA组(480例)。比较两组患者起搏器植入术后即刻、术后1w及术后1、6、12、18、24个月心室起搏电极相关的基本参数,术前、术后12、24月心脏彩超参数以及手术并发症。结果：RVOTS组术后即刻起搏阈值[(0.77±0.28)V]较RVA组[(0.53±0.17)V]高,差异有统计学意义(P0.05)。两组在术后1w及术后1、6、12、18、24个月起搏阂值差异无统计学意义(P0.05),两组感知及阻抗在不同时点的差异均无统计学意义(P0.05)。两组起搏参数均在可接受范围内且长期保持稳定。RVOTS组曝光时间[(18.76±7.3)min]较RVA组[(9.66士7.16)min]长,差异有统计学意义(P0.05)。术后12月RVA组LAD、LVEDD及LVESD较RVOTS组均增大,LVEF降低,但除外LVESD差异有统计学意义外,其余均无相关统计学意义。与RVOTS组相比,术后24月RVA组LAD、LVEDD及LVESD进一步增大,LVEF明显降低,差异均具有统计学意义。RVA组无心脏穿孔,RVOTS组发生7例,差异有统计学意义(P0.05)。结论：RVOTS起搏是可行的,长期随访起搏参数稳定。但是当主动螺旋电极固定于RVOTS并指向前壁或游离壁可能增加心脏穿孔风险。
[Abstract]:Objective: to investigate the long-term clinical efficacy and safety of right ventricular outflow tract septum pacing and right ventricular apical pacing. Methods: select the severe and slow diagnosis of right ventricular outflow tract septum pacing and right ventricular apical pacing in the first affiliated Hospital of Xinjiang Medical University from February 2007 to December 2013. One hundred and one hundred and one patients with cardiac arrhythmia were divided into RVOTS group (n = 521) and RVA group (n = 480) according to the fixed position of ventricular electrode. The basic parameters related to ventricular pacing electrodes at 1 week after operation and 1 month 1, 12 and 24 months after operation, cardiac color Doppler parameters before, 12 and 24 months after operation, and surgical complications. Results the threshold of immediate pacing in the RVA group [0.77 卤0.28 V] was higher than that in the RVA group [0.53 卤0.17V]. There was no significant difference in pacemaker threshold between the two groups at 1 week after operation and 1 month after operation (P 0.05). There was no significant difference in perception and impedance between the two groups at different time points (P 0.05). The pacing parameters of the two groups were in the acceptable range. The exposure time of RVOTS group [18.76 卤7.3 min] was longer than that of RVA group [9.66 卤7.16 min]. On December after operation, LVEDD and LVESD in RVA group were larger and lower than those in RVOTS group, but the rest had no statistical significance except the difference of LVESD. Compared with RVOTS group, LVEDD and LVESD in RVA group were significantly higher than those in RVOTS group on December. LVEDD and LVESD in RVA group decreased significantly 24 months after operation. There were 7 cases in RVOTS group without cardiac perforation, and the difference was statistically significant (P 0.05). Conclusion\% RVOTS pacing is feasible. Long-term follow-up pacing parameters are stable, but when the active spiral electrode is fixed to the RVOTS and points to the anterior or free wall, it may increase the risk of cardiac perforation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.7

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