右室不同起搏部位对老年病窦综合征患者左心室收缩功能的影响

目的：观察右室不同起搏部位对老年病窦综合征患者左室收缩功能的影响。方法：选取2013年3月～2015年3月在我院治疗并接受起搏器植入手术的90例老年病窦综合征患者为观察对象，根据其起搏器植入部位分为右室流出道组和右室心尖组，每组各45例患者。观察两组患者手术前后左心室收缩同步性和整体收缩功能；比较两组患者手术前后血流动力学的改变。结果：两组患者手术前左心室收缩同步性无明显差别，手术后，右室心尖组 Tmsv-16-SD、Tmsv-16-Dif 等左心室同步收缩性指标较右流出道组明显延长，而右流出道组患者的上述指标较手术前无明显变化；两组患者手术前左心室整体收缩功能无明显差别，手术后，两组患者的左心室整体收缩功能均较术前无明显改变，且两组间比较差别无统计学意义；手术前两组患者的血流动力学无明显差别，手术后，两组患者的心输出量（CO）均较术前无明显改变，而右室心尖组的 FS 和舒张期二尖瓣流速较术前明显降低，右流出道组的上述指标较术前差别无统计学意义。结论：起搏器植入右室流出道较右室尖部可更好地维持左心室收缩功能的同步性和血流动力学的稳定性，提示右室流出道起搏器植入对患者更为安全。

Effect of different pacing sites on left ventricular systolic function in elderly patients with sinus syndrome

Objective To observe the effect of different pacing sites of right ventricle on left ventricular systolic function in elderly patients with sinus syndrome. Methods 90 cases of elderly patients with sinus syndrome who were treated in our hospital from March 2013 to March 2015 were selected and divided into right ventricular outflow tract and right ventricular apical group, 45 patients in each group. Left ventricular systolic synchrony and systolic function were observed in two groups before and after opera-tion, and the changes of hemodynamics in two groups were compared before and after operation. Results There were no significant differences in left ventricular systolic synchrony between the two groups before operation, and the left ventricular systolic index such as Tmsv-16-SD、Tmsv-16-Dif in the right ventricular apex group was significantly longer than that of the right ventricular outflow tract group. The right outflow tract group of patients with the above indicators were not significantly changed compared with before surgery. There was no significant difference in left ventricular systolic function between the two groups before operation, and the left ventricular global systolic function of the two groups was not significantly changed compared with that before operation, and the difference between the two groups was not statistically significant. Before surgery the hemodynamics of patients in the two groups had no significant difference, after the operation, the cardiac output quantity (CO) of two groups had no difference, and the FS and diastolic mitral flow velocity of right ventricular apex group reduced right flow group, but the index of right ventricular outflow tract group had no statistically significant. Conclusions Right ventricular apex can maintain the stability of left ventricular systolic func-tion and the stability of left ventricular systolic function better than right ventricular apex.