彩超对人工心脏起搏的血液动力学研究

目的　本文采用彩色多普勒超声心动图研究了心脏起搏前、后的血液动力学变化 ,以评价不同起搏模式血液动力学效应。方法　对 32例植入人工心脏起搏器的患者 ,采用 M型、二维及多普勒超声心动图检测了心室按需起搏 (VVI)不伴室房逆传 (A组 )和伴室房逆传 (B组 )及房室顺序起搏 (AVP) (C组 )的左心结构、左室的泵血功能、左室收缩及舒张功能指标。结果　 1 .心室起搏 (VP)不伴室房逆传和房室顺序起搏(AVP)组起搏后的心输出量 (CO)明显增加 (P<0 .0 5〉,而 VP伴室房逆传组则 CO增加不明显 (P>0 .0 5 )。心搏量 (SV)各组均呈下降趋势 ,VP伴室房逆传者下降更明显。但起搏后三组间比较无显著差异 (P>0 .0 5 ) ;2 .VP后左室的收缩及舒张功能均有受损 ,而 AVP后主要损害左室的舒张功能 ,对左室收缩功能影响不明显 ;3.VP伴室房逆传者 ,起搏后血液动力学效应在三组间最差。结论　无论 VP还是 AVP起搏后由于心率的增加均可使CO增加 ,但对左室的功能均有不同程度的损害 ,VP伴室房逆传者最为明显 ,AVP损害程度三组间最轻。因此 ,AVP也并非真正的生理起搏器。临床上提倡埋植更接进生理状态的起搏器 (多部位心脏起搏 ) ,以保持良好的心功能状态

Hemodynamic Study on Artificial Cardiac Pacing Using Doppler Echocardiography

Objective In order to evaluate the hemodynamic effect of different pacing mode,we studied hemodynamic changes before and after the cardiac pacing.Methods Left ventricular structure,left ventricular pumping function,systolic function and diastolic function were studied with M Mode,2 dimensional and Doppler echocardiography in 32 patients treated by ventricular pacing(VP)with and without ventriculoatrial conduction and atrioventricular sequential pacing(AVP).Results 1.Cardiac output(CO)of pacing rhythm was significantly higher compared with CO of spontaneous rhythm in groups of VP without ventriculoatrial conduction and with AVP respectively( P <0 05),but not higher than that of VP with ventriculoatrial conduction( P >0 05).In all groups,the stroke volume(SV)showed a decreased tendency which was most obvious in the group of VP with ventriculoatrial conduction.However,after pacing the stroke volume of the three groups had no difference( P >0 05).2.The systolic and diastolic function of left ventricle were damaged in VP group,but in AVP group only was the diastolic function of left ventricle damaged,but the systolic function of left ventricle had obvious changes.3.Hemodynamic effects of VP with ventriculoatrial conduction group was the worst in all groups.Conclusions CO had been raised by increased heart rate in all groups,but the left ventricular function was damaged in different degrees.In the group of VP with ventriculoatrial conduction,the damage was the most serious,in the group of VP without ventriculoatrial conduction and in the group of AVP was the lesat.Therefore,atrialoventricular sequential pacemaker is not a real physiological pacemaker.We suggest that a kind of more closer physiological pacemaker(multisite cardiac pacing)should be implanted in patients with bradycardias to keep the cardiac function as good as possible.