医学综述
醫學綜述
의학종술
MEDICAL RECAPITULATE
2015年
8期
1511-1513
,共3页
老年房室传导阻滞%右心室间隔部%心脏起搏器%P波离散度
老年房室傳導阻滯%右心室間隔部%心髒起搏器%P波離散度
노년방실전도조체%우심실간격부%심장기박기%P파리산도
Atrioventricular block in elderly%Right ventricular septum%Cardiac pacemaker%Disper-sion degree of P wave
目的：探讨右心室间隔部（ RVS）植入起搏器对老年房室传导阻滞患者P波离散度（ Pd）的影响。方法选择2009年4月至2012年4月奎屯市伊犁州奎屯医院收治的心脏起搏器植入术患者的临床资料，共89例患者纳入研究，其中符合老年房室传导阻滞植入起搏器条件者82例，依据患者起搏器植入位置不同分为RVS组（43例）和右心室心尖部（RVA）组（39例）。分析 RVS对 Pd及相关指标的影响，并与RVA相比较。结果术后6个月，RVS组P波离散度（ Pd）、最大 P波显著低于RVA组（P＜0.01），QRS时限、QRS增量均显著低于 RVA组（P＜0.05或 P＜0.01），QRS波开始到主动脉血流出现时间-QRS波开始时间到肺动脉血流出现时间差值显著低于 RVA 组（ P ＜0.01）。RVS组患者持续性心房颤动发生率显著低于RVA组（ P＜0.05），而房性心律失常为1～2级的比例显著高于RVA组（P＜0.01）。 RVS组患者左心室舒张末内径及左心室射血分数均显著低于RVA组（P＜0.05或P＜0.01）。结论老年房室传导阻滞植入心脏起搏器时，相对于 RVA，RVS可减少对Pd的影响，降低术后心律失常发生率，减少术后心脏收缩不同步性，改善心脏收缩能力。
目的：探討右心室間隔部（ RVS）植入起搏器對老年房室傳導阻滯患者P波離散度（ Pd）的影響。方法選擇2009年4月至2012年4月奎屯市伊犛州奎屯醫院收治的心髒起搏器植入術患者的臨床資料，共89例患者納入研究，其中符閤老年房室傳導阻滯植入起搏器條件者82例，依據患者起搏器植入位置不同分為RVS組（43例）和右心室心尖部（RVA）組（39例）。分析 RVS對 Pd及相關指標的影響，併與RVA相比較。結果術後6箇月，RVS組P波離散度（ Pd）、最大 P波顯著低于RVA組（P＜0.01），QRS時限、QRS增量均顯著低于 RVA組（P＜0.05或 P＜0.01），QRS波開始到主動脈血流齣現時間-QRS波開始時間到肺動脈血流齣現時間差值顯著低于 RVA 組（ P ＜0.01）。RVS組患者持續性心房顫動髮生率顯著低于RVA組（ P＜0.05），而房性心律失常為1～2級的比例顯著高于RVA組（P＜0.01）。 RVS組患者左心室舒張末內徑及左心室射血分數均顯著低于RVA組（P＜0.05或P＜0.01）。結論老年房室傳導阻滯植入心髒起搏器時，相對于 RVA，RVS可減少對Pd的影響，降低術後心律失常髮生率，減少術後心髒收縮不同步性，改善心髒收縮能力。
목적：탐토우심실간격부（ RVS）식입기박기대노년방실전도조체환자P파리산도（ Pd）적영향。방법선택2009년4월지2012년4월규둔시이리주규둔의원수치적심장기박기식입술환자적림상자료，공89례환자납입연구，기중부합노년방실전도조체식입기박기조건자82례，의거환자기박기식입위치불동분위RVS조（43례）화우심실심첨부（RVA）조（39례）。분석 RVS대 Pd급상관지표적영향，병여RVA상비교。결과술후6개월，RVS조P파리산도（ Pd）、최대 P파현저저우RVA조（P＜0.01），QRS시한、QRS증량균현저저우 RVA조（P＜0.05혹 P＜0.01），QRS파개시도주동맥혈류출현시간-QRS파개시시간도폐동맥혈류출현시간차치현저저우 RVA 조（ P ＜0.01）。RVS조환자지속성심방전동발생솔현저저우RVA조（ P＜0.05），이방성심률실상위1～2급적비례현저고우RVA조（P＜0.01）。 RVS조환자좌심실서장말내경급좌심실사혈분수균현저저우RVA조（P＜0.05혹P＜0.01）。결론노년방실전도조체식입심장기박기시，상대우 RVA，RVS가감소대Pd적영향，강저술후심률실상발생솔，감소술후심장수축불동보성，개선심장수축능력。
Objective To explore the impact of pacemaker implanted in right ventricular septum ( RVS) on the of P wave dispersion (Pd) in elderly patients with atrioventricular block.Methods A total of 89 cases of patients with cardiac pacemaker implantation admitted in Kuitun Hospital of Xinjiang Uygur Autono-mous Region Yili Kazak Autonomous Prefecture from Apr .2009 to Apr.2012 were selected as research objects,while 82 cases met the conditions of pacemaker implantation in elderly patients with atrioventricular block,according to the different positions of pacemaker implantation ,patients were divided into RVS group (43 cases) and right ventricular apex(RVA) group(39 cases).The effect of RVS on Pd and related indexes were analyzed,and compared with effect of RVA on Pd.Results Six months after surgery,Pd,maximum P wave in RVS group were significantly lower than those of RVA group(P <0.01); QRS time,QRS incre-ments in RVS group were significantly lower than those in RVA group(P<0.05 or P <0.01);difference between time from beginning of QRS wave to occurrence of aortic blood flow and time from beginning of QRS wave to occurrence of pulmonary artery blood flow in group RVS was lower than that in RVA group ( P <0.01).Incidence of persistent atrial fibrillation in RVS group was significantly lower than that in RVA group (P<0.05),and proportion of grade 1-2 atrial arrhythmia was significantly higher than that in RVA group (P<0.01).Left ventricular end diastolic diameter and left ventricular ejection fraction in RVS group were significantly lower than those in RVA group(P<0.05 or P<0.01).Conclusion When implanting pace-maker to elderly patients with atrioventricular block,RVS can reduce the influence on dispersion degree of P wave compared with RVA,and reduce the incidence of postoperative cardiac arrhythmia,as well as postopera-tive cardiac dyssynchrony,improve the cardiac contractility.
