心脏起搏器综合征患者心室失同步化和收缩功能的变化.pdfVIP

· l108· !生 箍 鲞第l2期 Chin J Cardiol。December 2007．Vo1．35 No．12 ． 心脏起搏研究 ． 心脏起搏器综合征患者心室失同步化 和收缩功能的变化 周德震 韦凡平 袁高辉 程震锋 【摘要】 目的 研究心脏起搏器综合征(PMS)患者心室失同步化和收缩功能的变化。方法 14例心房颤动患者为对照组；因慢室率心房颤动安置心室按需型永久起搏器(VVI)的患者中．16例 安置后出现PMS的患者为PMS组，18例未出现PMS的患者为无PMS组。用组织多普勒影像技术测 定左、右心室侧壁和室间隔的收缩峰值速度、加速度和达峰时间。结果 观察组左、右心室侧壁收缩 期峰值速度、加速度较对照组明显下降(P0．05)；左心室侧壁与室间隔的收缩达峰时间间隔较对照 组显著延长(P0．01)，右心室侧壁与室间隔的收缩达峰时间间隔较对照组显著缩短(P0．01)。 PMS组与无PMS组比较，左、右心室侧壁室间隔的收缩期峰值速度、加速度、左室侧壁与室间隔的收 缩达峰时间间隔差异无统计学意义(P0．05)，而右室侧壁与室间隔的收缩达峰时间间隔差异有统 计学意义(P0．01)。结论 右室失同步化是PMS中的一个重要因素，而心室收缩功能的变化和左 室失同步化并不重要。 【关键词】 起搏器，人工；超声心动描记术；心脏功能试验 Right ventricular desynchronizatlon in patients jm pacemaker syndrome zHoU De—zhen．WEl Fan— ping．YUAN Gao—hui．CHENG Zhen ng．Department of Cardiology，Huzhou Central Hospital，Huzhou 3l30oo．China 【Abstract l Objective To observe tl1e incidence of ventricular desynchronization in patients witl1 or tl1out pacemaker syndrome(PMS)．Methods The systolic peak velocity．tl1e acceleration and tl1e time to peal【velocity of the interventricular septum(ⅣS)，left ventricular(LV)and right ventricular(RV)lateral wall were detected by tissue Doppler imaging(TD!)in 14 atrial fibrillation patients without pacemaker implantation(contro1)．18 atrial fibrillation patients witl1out PMS and 16 atrial fibrillation patients witl1 PMS．All patients were free of valve disease，myocardial infarction．severe pulmonary hypertension，low left ventricular eject fraction(≤50％)，significant segmental hypokinesis of ventricular wall or complete bundle branch block．Results Compared to tl1e control patients．tl1e systolic peak velocity and tl1e accelerations on lateral walls oftl1e LV and RV reduced significantly in patients witl1 implanted pacemakers(P0．05)．，n1e intervals to peak velocity of the IVS and LV lateral walls were significantly prolonged[PMS group(8o．13± 26．92)ms v(