右室流入道间隔部和心尖部起搏的临床疗效对比

目的探讨右室流入道间隔部（RVIS）和右室心尖部（RVA）起搏,治疗缓慢性心律失常神经内分泌激素和心功能的变化。方法 106例行DDD起搏器治疗的患者：男86例,女20例,年龄45～86岁,平均76岁,随机分为：右室流入道间隔部起搏组（RVIS起搏组）56例,右室心尖部起搏组（RVA起搏组）50例。2组心房电极均植入右心耳梳状肌内,RVIS起搏组心室电极植入右室流入道间隔部、RVA起搏组心室电极植入右室心尖部。分别观察2组在起搏器植入时、起搏3个月和6个月不同时期,血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、心钠肽（BNP）和去甲肾上腺素（NE）等神经内分泌激素的含量;用彩色多普勒超声心动图测定：心排血量（CO）、每搏输出量（SV）、射血分数（EF）、左室舒张末内径（LVDd）和左室短轴缩短分数（FS）。结果 RVA起搏组治疗后其神经内分泌激素和心功能,较起搏治疗前恶化,且随着起搏时间的延长趋于明显,而RVIS起搏组,其神经内分泌激素和心功能改变,较起搏治疗前明显改善,且随着起搏时间的延长改善的越明显,与RVA起搏组比较,具有统计学意义（P〈0.05）。结论 RVIS起搏优于RVA起搏,可明显改善心功能,纠正神经内分泌激素失调,值得临床推广。

Clinical Comparative Study of Right Ventricular Inflow Tract Septal Pacing and Right Ventricular Apical Pacing

Objective To investigate the changes of neuroendocrine hormone and cardiac function in arrhythmia patients when treated by right ventricular inlet septal（RVIS） pacing or right ventricular apex（RVA） pacing. Methods A total of 106 patients treated with DDD pacemaker：86 cases of male and 20 female,aged 45～86 years,mean 76 years,were randomly divided into two groups：the right ventricular inlet septal pacing group（RVIS pacing group） 56 cases,right ventricular apical pacing（RVA pacing group） 50 cases.In the two groups,the atrial electrode were implanted in the right atrial appendage comb muscles,RVIS ventricular pacing electrodes implanted at right ventricular inlet septal,RVA pacing ventricular leads implanted in right ventricular apex.The two groups were observed in the pacemaker implantation,the pacing for 3 months and 6 months,measured the plasma renin activity（PRA）,angiotensin Ⅱ（Ang Ⅱ）,aldosterone（ALD）,cardiac natriuretic peptide（BNP） and norepinephrine（NE） and other neuroendocrine hormone levels;use color Doppler echocardiography：cardiac output（CO）,stroke volume（SV）,ejection fraction（EF）,left chamber end diastolic diameter（LVDd） and left ventricular fractional shortening fraction（FS）. Results In RVA pacing group,the neuroendocrine hormones and their heart function deteriorated compared with before pacing,and became more obvious with the time went on,but in RVIS pacing group,the neuroendocrine hormone and cardiac function significantly improved,compared before pacing,and with the time pacing the more obvious improvement.Compared with RVA pacing,there were significant difference（P0.05） in RVIS group. Conclusion Compared with RVA pacing,RVIS pacing can significantly improve cardiac function,correct the imbalances of neuroendocrine hormones,it is worthy of promotion.