右室室间隔起搏与心尖部起搏对心功能影响的比较

目的 比较右室室间隔起搏与心尖部起搏对患者心功能的影响。方法 180例患者随机分为右室室间隔部起搏组（n=98例）和右室心尖起搏组（n=82例）。比较两组患者术前与术后第18个月心脏彩超的变化。 结果 间隔组患者的左室射血分数（LVEF）较术前显著提高 ［（66±8）% vs （69±9）%,P<0.01］，心搏出量（SV）较术前显著提高［（83±15）ml vs (87±12）ml,P<0.01］，左室舒张末期内径(LVEDD)缩小未达显著水平［(52±5)mm vs (51±5)mm］,左室收缩末期内径(LVESD)无明显变化［(31±5)mm vs (31±5)mm］,而心尖组LVEF显著降低［(68±7)% vs (63±8)%,P<0.01］，SV显著减少了7 ml［(87±16)ml vs (80±10)ml,P<0.01］，LVEDD显著增大3 mm［(50±6)mm vs (53±7)mm，P<0.01］，LVESD显著增大 ［（30±5）mm vs (32±6）mm，P<0.05］，两组患者各观察指标同期比较术前无统计学意义,术后18个月LVEF差异有非常显著统计学意义（P<0.01），SV差异有统计学意义（P<0.05）。结论 右室室间隔起搏较右室心尖部起搏更利于起搏器植入患者的心功能保护。

Comparison of cardiac function between right ventricular septal pacing and right ventricular apex pacing

AIM: To compare the cardiac function between right ventricular septal pacing and right ventricular apex pacing. METHODS: A total of 180 cases were randomly divided into ventricular septal pacing group (n=98 cases) and apex pacing group (n=82). Changes in the echocardiogram of the two groups were compared before surgery and 1.5 years after surgery. RESULTS: Left ventricular ejection fraction (LVEF) in septal group increased ［(66±8)% vs.(69±9)%, P<0.01］, stroke volume (SV) increased ［(83±1)ml vs.(87±12)ml, P<0.01］, left ventricular end-diastolic diameter (LVEDD) decreased ［(52±5)mm vs.(51±5)mm］, and no significant change was found in left ventricular end-systolic diameter (LVESD) ［(31±5)mm vs.(31±5)mm］. In apex group, LVEF significantly decreased ［(68±7)% vs.(63±8)%, P<0.01］, SV significantly decreased ［(87±16) ml vs.(80±10) ml, P<0.01］, and a significant increase was found in LVEDD ［(50±6)mm vs.(53±7)mm, P<0.01］ and in LVESD ［(30±5)mm vs.(32±6)mm, P<0.05］. Eighteen months after operation, LVEF (P<0.01) and SV (P<0.05) were significantly different between groups. Pre- and postoperative difference between groups was statistically significant (P<0.05). CONCLUSION: Ventricular septal pacing is superior to right ventricular apex pacing in improving cardiac function in patients with pacemaker implant.