右心室不同部位起搏对心脏结构和左心功能的影响

[目的]对比研究右心室不同部位起搏对患者心脏结构和左心功能的影响.[方法]90例Ⅲ度或高度房室传导阻滞患者, 随机分为三组, A组行右室流入道（RVIS）间隔部起搏,B组行右室流出道（RVOT）间隔部起搏,C组行右心室心尖部（RVA）起搏. 观察三组手术中情况,监测术中血流动力学变化及手术曝光时间,比较三组术后随访的起搏器工作情况,心电图QRS波宽度,左心功能及血浆中B型钠尿肽（BNP）的差异.[结果]术中监测血流动力学,A组及B组明显优于C组.术后随访观察,A组及B组心电图QRS波宽度明显窄于C组,A组及B组具有更好的心脏功能.[结论]右心室间隔部起搏无论右室流出道起搏还是右室流入道间隔部起搏都是安全,有效的,比右室心尖部起搏更有利于双心室电激动的同步性,且长期对心脏结构及心功能影响也较少.

Study on the Effects of the Pacing of Different Part of Right Ventricular on Cardiac Structure and Function of Left Heart

[Objective]To compare the effects of the pacing of different part of right ventricular on cardiac structure and left ventricular function. [Methods] Totally 90 patients with Ill-degree or advanced atrioventrieular block were randomly divided into three groups. RVIS group underwent the pacing of the septum of right ventricular inflow tract. RVOT group underwent the pacing of the septum of right ventricular outflow tract. RVA group underwent the pacing of right ventrieular apex. The intraoperative status in 3 groups was observed. The change in hemodynamics and the time of surgical exposure were monitored. The operation condi tion of the pacemakers followed up after surgery, the width of QRS wave in electrocardiogram（ECG）, left ventricular function and plasma B-type natriuretic peptide（BNP） were compared among 3 groups. [Results] The intraoperative hemodynamics in RVIS group and RVOT group were significantly better than that in RVA group. Postoperative follow-up observation showed that the width of QRS in ECG of RVIS group and RVOT group were significantly narrower than that in RAV group. RVIS group and RVOT group had better cardiac function. [Conclusion] Right ventricular septum pacing of both right ventricular outflow tract or right ventricular inflow tract is safe and effective, and better for the synchronism of the electrization of both ventricles than the right ventricular apex pacing, and has less effect on the cardiac structure and function.