X线指导右室流出道间隔部起搏影响因素分析-心血管内科学专业论文.docxVIP

解放军医学院硕士学位论文 解放军医学院硕士学位论文 PAGE 10 PAGE 10 万方数据 组和游离壁组。两组患者术前心电图心前移形指数（TZI）存在显著差异 （ P=0.000 ）， 左 室 侧 径 存 在 显 著 差 异 （ P=0.03）， 右 室 内 径 无 显 著 差 异 （P=0.29），左右室比例无显著差异（P=0.65）。术后心室起搏心电图间隔 组起搏及游离壁组ⅡⅢ avF 导联 QRS 主波方向均为向上。间隔组Ⅰ avL 导联 QRS 形态多为 QS 型，占所有间隔部位起搏 74.2%，而游离壁组Ⅰ avL 导联 QRS 形态多为 R 型及 Rs 型，占游离壁起搏 72.5%。 研究结论 X 线指导右室流出道（RVOT）间隔部位起搏植入过程受到患者心脏 转位、左室大小等较多因素影响，准确性有限，需结合超声心动及心电图 等其他手段辅助。超声影像在观察电极位置的应用中，能够在不同界面、 不同角度清晰观察电极与各解剖标志的关系，且操作简单，应用性较高。 术后心室起搏心电图（ECG）对于不同起搏位点有较为鲜明的特点，可以 做为辅助手段帮助植入过程中电极定位。 关键词：右室流出道间隔；起搏电极植入；影响因素；X 线；超声心动； 心电图 Analysis of influence factors of the X-ray guidance for the right ventricular outflow tract sepal pacing Abstract Objective: Long-term right ventricular apex pacing may lead to decreased the function of left ventricular, increased the incidence of atrial fibrillation and the risk of death. The main reason that may be delayed left ventricular activation, long QRS interval, and dyssynchronous RV-LV activation. Compared with right ventricular apex(RVA) pacing, right ventricular sepal pacing may be more physiological. Because the sepal is on the normal physiological activation sequence point of heart, so the pacing can accurately transfer the activation to bundle branch first, and then to the Kemp wild fibers, which makes the heart work at the normal physiological activation sequence. These can improve cardiac function greatly and get more narrow interval of QRS. Owing to the complicated structure of the right ventricular outflow tract(RVOT), electrode implantation sites exist variability. Now pacemaker implantation mostly be conducted under the guidance of X-ray. By the two-dimensional echocardiography on chest as a gold standard to evaluate the accuracy of sites which X-ray guidance electrode implantation, and to analyse the influence factors. To sum up the characteristics of the ECG of right ventricular outflow tract and free wall pacing, which in order to better guide the right ventricular outflow tract spetal pacing. Methods: There were 102 p