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目的运用组织多普勒方法测量心脏机械活动的同步性,了解右室不同部位起搏后左心室同步性和收缩功能的即刻变化。方法选择拟行心内电生理检查的患者9例,排除器质性心脏病。在右室心尖部、右室低位室间隔、右室流出道游离壁和间隔部按随机的顺序行房室顺序起搏,采集彩色编码的组织多普勒图像进行下线分析。计算整体收缩振幅(GLOBAL SYSTOLIC CONTRACTIONAMPLITUDE,GSCA)和16节段峰值收缩速度和位移达峰时间的标准差TS-SD与TDIS-SD。结果右室流出道游离壁或间隔部起搏的GSCA显著高于右室心尖部或低位间隔起搏时,但低于基础状态(P<0·05)。右室心尖部起搏与右室流出道间隔部起搏的节段收缩位移比较显示,右室心尖部起搏时左室侧壁、后壁和下壁的平均位移显著降低(P<0·05),余节段差异无统计学意义。右室心尖部或低位室间隔起搏时,组织位移曲线由正常时的单峰变为双峰或三峰,且舒张末期出现负相位移,组织速度曲线出现等容收缩峰增高。TDIS-SD和TS-SD在右室各部位起搏时均较基础状态时显著降低(P<0·01),但各部位起搏之间的差异无统计学意义。结论右室起搏即刻导致左心室内收缩非同步现象和左心收缩功能的下降。右室流出道起搏较右室心尖部起搏和低位室间隔起搏对左室收缩功能的影响小,是一种较为理想的起搏部位。
Objective To measure the synchronization of cardiac mechanical activities by tissue Doppler and to understand the immediate change of left ventricular systolic and systolic function after pacing in different parts of right ventricle. Methods Nine patients undergoing elective electrophysiological examination were selected to exclude organic heart disease. Right ventricular apex, low right ventricular septum, right ventricular outflow tract free wall and the interval in a random order atrioventricular pacing, color-coded tissue Doppler images were collected for off-line analysis. Standard deviations TS-SD and TDIS-SD were calculated for GLOBAL SYSTOLIC CONTRACTIONAMPLITUDE (GSCA) and peak-to-peak systolic velocity and peak-to-peak displacement at 16 segments. Results The right ventricular outflow tract free wall or septal pacing GSCA was significantly higher than right ventricular apex or low interval pacing, but lower than the basic state (P <0.05). Comparisons of segment systolic displacement of right ventricular apical pacing and right ventricular outflow tract pacing showed that the average displacement of left ventricular lateral wall, posterior wall and inferior wall was significantly decreased in right ventricular apical pacing (P <0 · 05), the remaining segment was no significant difference. Right ventricular apical or low ventricular septal pacing, the tissue displacement curve from the normal single peak to double or triple peak, and diastolic phase negative phase shift, tissue velocity curve appears isovolumic peak increased. TDIS-SD and TS-SD were significantly lower than those of basal pacing in all parts of right ventricle (P <0.01), but there was no significant difference in pacing between different parts. Conclusion Right ventricular pacing immediately leads to left ventricular systolic asynchrony and decreased left ventricular systolic function. Right ventricular outflow tract pacing than right ventricular apical pacing and low ventricular septal pacing on left ventricular systolic function is small, is an ideal pacing site.