生理性起搏器治疗缓慢型心律失常的临床观察

目的探讨生理性起搏器在缓慢型心律失常中的临床疗效与安全性。方法共85例患者，起搏器包括双腔起搏器DDD心房＋心室（起搏心腔）；心房＋心室（感知心腔）；双重（1抑制＋T触发）（感知后反应方式）]60例，双腔起搏器VDD心室（起搏心腔）；心房＋心室（感知心腔）；双重（1抑制＋T触发）（感知后反应方式）]3例，双腔起搏器VVIR心房＋心室（起搏心腔）；心房＋心室（感知心腔）十（1抑制）（感知后反应方式）；R频率调整（程控功能）]22例。结果85例患者均手术成功，术中测得心室起搏阈值为（0．42±0．13）V／0．5ms，阻抗（560±130）Ω，R波振幅（9．8±2．2）mV；右心房起搏阈值为（0．89±0．27）V／0．5ms，阻抗（670±180）Ω，P波振幅（2．8±1．2）mV，P波感知灵敏度（0．48±0．3）mV。A—V间期程控在140-160ms，频率适应参数程控为反应时间和恢复时间取中档值，增益取低档值，下限频率程控为60-70次／min，上限频率程控于110-130次／min，感知阈值取中档，频率适应档次取4～5。随访4-50个月，所有患者的生活质量明显提高，无起搏器并发症发生。结论生理性起搏可产生较好的血液动力学效应，改善心功能，提高运动耐量，对有适应证的起搏器患者应首先推荐使用各类生理性起搏器。

The clinical effect of physiological pacing in 85 patients with bradyarrhythmia

Objective To evaluate the clinical effect of physiological pacing in bradyarrhythmias.Methods 885 patients were planted with physiological pacemaker, including 60 cases with DDD, 3 cases with VDD, 22 cases with VVIR and 1 case with three chamber biatrial pacemaker. The electrode leads were positioned through subclavian vein. Results The pacing threshold of right ventrieular leads were （0.42±0.13）V,the resistence were （560±130）Ω and the amplitude of R wave were （9.8±2.2）mV.The pacing threshold of right atrial leads were （0.89± 0.27）V, the resistance were （670±180）Ω, the amplitude of P wave were （2.8＋1.2）mV.The AV intervals of dual chamber pacemakers were programmed from 140-160 ms. The rate-adaptive parameters were set at middle value. There were no complications. Conclusion Physiological pacing may improve the hemodynamic conditions and can be applied safely to patients with hradyarrhythmias.