中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
7期
796-800
,共5页
起搏器%心肺复苏%复苏后自主循环
起搏器%心肺複囌%複囌後自主循環
기박기%심폐복소%복소후자주순배
Pacemakers%Cardiopulmonary resuscitation%Restoration of spontaneous circulation
目的 比较右心室流出道室间隔部起搏与心尖部起搏对复苏后血流动力学和心血管事件的影响.方法 选择深圳市龙岗区人民医院2010年11月至2014年1月收治的76例患者,经心电监护或心电图证实院内心搏呼吸骤停,接受心肺复苏联合经静脉临时心脏起搏术、成功建立有效循环、年龄≥18岁.入选病例排除因各种疾病终末期、晚期肿瘤、自然死亡因素所致心搏呼吸停止者.随机对76例在急诊抢救单元的X线透视确定其起搏位置,根据起搏位置的不同分为右心室流出道室间隔部起搏组36例[男26例,女10例,年龄(57.31±16.65)岁]和心尖部起搏组40例[男22例,女18例,年龄(60.43 ±15.48)岁].所有患者行心电图检查测量起搏后QRS波群时限,并在早期至中间阶段通过床边超声心动图检查左室射血分数(LVEF)、左室短轴缩短率(FS);通过无创血流动力学监测泵功能指数心排量(CO)和心脏指数(CI).并在自主循环恢复后早期至中间阶段记录两组心血管事件的发生.所有数据采用SPSS 13.0统计软件进行分析.结果 两组患者在年龄、性别、原发病构成比、心脏骤停到自主循环恢复时间、肾上腺素用量等方面差异无统计学意义(P＞0.05).在自主循环恢复的早期至中间阶段,与心尖部起搏组比较,右心室流出道室间隔部起搏组在LVEF、FS、CO、CI均升高(0.46±0.04)％vs.(0.44±0.05)％、(0.34±0.05) vs.(0.32±0.04)、(3.73±0.46) L/min vs.(3.47±0.46) L/min、(2.67±0.29)L/ (min·m2)v s.(2.46±0.26)L/(min·m2),P＜0.05;右心室流出道室间隔部起搏组QRS时限较心尖起搏组显著缩短(128.25 ±6.06) ms vs.(151.93 ±8.99) ms,P＜0.05;房颤发生率明显下降,但心衰和新血栓事件差异无统计学意义(P＞0.05).结论 心肺复苏后自主循环早期右心室流出道室间隔部起搏有利于稳定血流动力学,减少房颤的发生.
目的 比較右心室流齣道室間隔部起搏與心尖部起搏對複囌後血流動力學和心血管事件的影響.方法 選擇深圳市龍崗區人民醫院2010年11月至2014年1月收治的76例患者,經心電鑑護或心電圖證實院內心搏呼吸驟停,接受心肺複囌聯閤經靜脈臨時心髒起搏術、成功建立有效循環、年齡≥18歲.入選病例排除因各種疾病終末期、晚期腫瘤、自然死亡因素所緻心搏呼吸停止者.隨機對76例在急診搶救單元的X線透視確定其起搏位置,根據起搏位置的不同分為右心室流齣道室間隔部起搏組36例[男26例,女10例,年齡(57.31±16.65)歲]和心尖部起搏組40例[男22例,女18例,年齡(60.43 ±15.48)歲].所有患者行心電圖檢查測量起搏後QRS波群時限,併在早期至中間階段通過床邊超聲心動圖檢查左室射血分數(LVEF)、左室短軸縮短率(FS);通過無創血流動力學鑑測泵功能指數心排量(CO)和心髒指數(CI).併在自主循環恢複後早期至中間階段記錄兩組心血管事件的髮生.所有數據採用SPSS 13.0統計軟件進行分析.結果 兩組患者在年齡、性彆、原髮病構成比、心髒驟停到自主循環恢複時間、腎上腺素用量等方麵差異無統計學意義(P＞0.05).在自主循環恢複的早期至中間階段,與心尖部起搏組比較,右心室流齣道室間隔部起搏組在LVEF、FS、CO、CI均升高(0.46±0.04)％vs.(0.44±0.05)％、(0.34±0.05) vs.(0.32±0.04)、(3.73±0.46) L/min vs.(3.47±0.46) L/min、(2.67±0.29)L/ (min·m2)v s.(2.46±0.26)L/(min·m2),P＜0.05;右心室流齣道室間隔部起搏組QRS時限較心尖起搏組顯著縮短(128.25 ±6.06) ms vs.(151.93 ±8.99) ms,P＜0.05;房顫髮生率明顯下降,但心衰和新血栓事件差異無統計學意義(P＞0.05).結論 心肺複囌後自主循環早期右心室流齣道室間隔部起搏有利于穩定血流動力學,減少房顫的髮生.
목적 비교우심실류출도실간격부기박여심첨부기박대복소후혈류동역학화심혈관사건적영향.방법 선택심수시룡강구인민의원2010년11월지2014년1월수치적76례환자,경심전감호혹심전도증실원내심박호흡취정,접수심폐복소연합경정맥림시심장기박술、성공건립유효순배、년령≥18세.입선병례배제인각충질병종말기、만기종류、자연사망인소소치심박호흡정지자.수궤대76례재급진창구단원적X선투시학정기기박위치,근거기박위치적불동분위우심실류출도실간격부기박조36례[남26례,녀10례,년령(57.31±16.65)세]화심첨부기박조40례[남22례,녀18례,년령(60.43 ±15.48)세].소유환자행심전도검사측량기박후QRS파군시한,병재조기지중간계단통과상변초성심동도검사좌실사혈분수(LVEF)、좌실단축축단솔(FS);통과무창혈류동역학감측빙공능지수심배량(CO)화심장지수(CI).병재자주순배회복후조기지중간계단기록량조심혈관사건적발생.소유수거채용SPSS 13.0통계연건진행분석.결과 량조환자재년령、성별、원발병구성비、심장취정도자주순배회복시간、신상선소용량등방면차이무통계학의의(P＞0.05).재자주순배회복적조기지중간계단,여심첨부기박조비교,우심실류출도실간격부기박조재LVEF、FS、CO、CI균승고(0.46±0.04)％vs.(0.44±0.05)％、(0.34±0.05) vs.(0.32±0.04)、(3.73±0.46) L/min vs.(3.47±0.46) L/min、(2.67±0.29)L/ (min·m2)v s.(2.46±0.26)L/(min·m2),P＜0.05;우심실류출도실간격부기박조QRS시한교심첨기박조현저축단(128.25 ±6.06) ms vs.(151.93 ±8.99) ms,P＜0.05;방전발생솔명현하강,단심쇠화신혈전사건차이무통계학의의(P＞0.05).결론 심폐복소후자주순배조기우심실류출도실간격부기박유리우은정혈류동역학,감소방전적발생.
Objective To observe the impact of different pacing sites in hemodynamic and cardiovascular events after restoration of spontaneous circulation.Methods A total of 76 patients with-in hospital cardiac arrest occurred from November 2010 to January 2014 were confirmed by electrionic device monitoring or electrocardiogram and they received cardiopulmonary resuscitation,and their ages were over 18 years.Patients with end-stage of various disease,malignancy and cardiac arrest due to incurable diseases or debility of physical conditions were excluded.The 76 patients were divided into two groups according to pacing site checked by X-ray fluoroscopy in emergency rescue unit:right ventriclular outflow trace pacing group [n =36,male 26 cases,female 10 cases,age (57.31 ± 16.65) years] and right ventricular apex pacing group [n =40,22 male cases and 18 female cases,age (60.43 ± 15.48) years].All patients' QRS duration were measured by ECG after pacemaker implantition and left ventricular ejection fraction (LVEF),left ventricular short axis reduced rate (FS),heart rate (HR),cardiac index (CI) were tested by bedside echocardiography and non-invasive hemodynamic monitoring was used during the early to middle stage.All the hemodynamic variables and the cardiac events were observed after spontaneous circulation recovery.All the data were analyzed by SPSS version 13.0 statistical software.Results There were no significant differences in age,gender,the primary disease,the time from cardiac arrest to spontaneous circulation restoration and dosage of epinephrine (P ＞ 0.05).In comparison with right ventricular apex pacing group,LVEF,FS,HR,CI were higher in right ventriclular outflow trace pacing group [(0.46 ± 0.04)％ vs.(0.44 ±0.05)％,(0.34±0.05) vs.(0.32±0.04),(0.04±0.46) L/minvs.(3.47±0.46) L/min,(0.46±0.29) L/ (min · m2) vs.(2.46 ±0.26) L/ (min · m2),P ＜ 0.05] and right ventriclular outflow trace pacing group had shorter QRS duration than right ventriclular apex pacing group [(128.25 ± 6.06) ms vs.(151.93 ± 8.99) ms,P ＜ 0.05]; fewer atrial fibrilation event was detected in right ventriclular outflow trace pacing group after restoration of spontaneous circulation than that in right ventricular apex pacing group.But incidences of cardiac failure and thrombus were not different between two groups (P ＞ 0.05).Conclusions The right ventriclular outflow trace pacing resulted in better hemodynamic and fewer atrial fibrilation after restoration of spontaneous circulation.
