CAJ | 학술논문

[目的]评价右心室不同起搏方式对心衰犬心功能及心室同步的影响。[方法]12只心衰犬，采用自身对照方法随机行右房-右室心尖部（RVA）、右房-右室流出道间隔部（RVS）、右房-右室双部位（RV-Bi）、右房-双室（Bi-V ）起搏，起搏频率180次/分钟，每种方式起搏前及起搏稳定15 min后行彩色多普勒超声心动图检查，测定左心室舒张末期直径（LVEDd）、左室射血分数（LVEF）、室间机械延迟（IVMD）、室间隔与左室后壁运动延迟（SPWMD）、左心室12个节段达峰时问的标准差（Ts-SD ）。[结果]与起搏前及 RVA起搏相比，RVS、RV-Bi、Bi-V 起搏时的 LVEDd、IVMD、SPWMD、Ts-SD减小，LVEF增加，其差异有显著性（ P ＜0．05）；与RVS起搏相比，RV-Bi及Bi-V起搏时的LVEDd、IVMD、SPWMD、Ts-SD减小，LVEF增加，其差异有显著性（ P ＜0．05）；与 Bi-V 起搏相比，RV-Bi起搏时的 SPWMD、Ts-SD增加，其差异有显著性（ P ＜0．05），而LVEDd、IVMD、LVEF差异无显著性（ P ＞0．05）。[结论]对心衰犬，RV-Bi起搏疗效明显，可作为心脏再同步化治疗（CRT ）的备选模式，RVS起搏有效但疗效欠佳，RVA起搏则无效。
[목적]평개우심실불동기박방식대심쇠견심공능급심실동보적영향。[방법]12지심쇠견，채용자신대조방법수궤행우방-우실심첨부（RVA）、우방-우실류출도간격부（RVS）、우방-우실쌍부위（RV-Bi）、우방-쌍실（Bi-V ）기박，기박빈솔180차/분종，매충방식기박전급기박은정15 min후행채색다보륵초성심동도검사，측정좌심실서장말기직경（LVEDd）、좌실사혈분수（LVEF）、실간궤계연지（IVMD）、실간격여좌실후벽운동연지（SPWMD）、좌심실12개절단체봉시문적표준차（Ts-SD ）。[결과]여기박전급 RVA기박상비，RVS、RV-Bi、Bi-V 기박시적 LVEDd、IVMD、SPWMD、Ts-SD감소，LVEF증가，기차이유현저성（ P ＜0．05）；여RVS기박상비，RV-Bi급Bi-V기박시적LVEDd、IVMD、SPWMD、Ts-SD감소，LVEF증가，기차이유현저성（ P ＜0．05）；여 Bi-V 기박상비，RV-Bi기박시적 SPWMD、Ts-SD증가，기차이유현저성（ P ＜0．05），이LVEDd、IVMD、LVEF차이무현저성（ P ＞0．05）。[결론]대심쇠견，RV-Bi기박료효명현，가작위심장재동보화치료（CRT ）적비선모식，RVS기박유효단료효흠가，RVA기박칙무효。
[Objective] To evaluate the efficacy of different right ventricular pacing modes for the treat-ment of heart failure .[Methods]Self control method was used .Twelve dogs with heart failure randomly re-ceived right atrium-right ventricular apex (RVA) ,right atrium-right ventricular septal(RVS) ,right atrium-right ventricular bifocal(RV-Bi) and biventricular(Bi-V) pacing ,respectively .The pacing frequency was 180 times per minute .Color Doppler echocardiography was performed before and 15min after pacing .Left ventric-ular end-diastolic diameter(LVEDd) ,left ventricular ejection fraction(LVEF) ,interventricular mechanical de-lay(IVMD) ,interventricular septum and left ventricular posterior wall motion delay (SPWMD) and left ven-tricular 12-segment peak time standard deviation(Ts-SD) were measured .[Results]Compared with before pa-cing and RVA pacing ,LVEDd ,IVMD ,SPWMD and Ts-SD decreased and LVEF increased in RVS ,RV-Bi and Bi-V pacing ,and there was significant difference ( P < 0 .05) .Compared with RVS pacing ,LVEDd , IVMD ,SPWMD and Ts-SD decreased and LVEF increased in RV-Bi and Bi-V pacing ,and there was signifi-cant difference( P<0 .05) .Compared with Bi-V pacing ,SPWMD and Ts-SD increased in RV-Bi pacing ,and there was significant difference( P <0 .05) .There was no significant difference in LVEDd ,IVMD and LVEF ( P<0 .05) .[Conclusion]RV-Bi pacing for the treatment of heart failure has obvious efficacy ,and can be used as an alternative mode for cardiac resynchronization therapy (CRT ) .RVS pacing is effective but has poor effi-cacy .RVA pacing is ineffective .