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目的:探讨最佳房室间期(AVD)的设置和管理方法。方法:选择因高度或完全性房室传导阻滞而安置双腔起搏器的患者,研究组(23例)通过超声心动图指导进行感知房室间期的优化,对照组(21例)则常规设置房室间期。对比起搏器植入后1周和7个月2组患者超声心动图的变化以及心房颤动和心力衰竭的发生率。结果:(1)研究组的AVD为(138.7±8.7)ms,对照组的AVD为(124.8±0.8)ms(P<0.001)。(2)起搏器植入后1周,2组患者的超声心动图指标无显著差异。(3)随访结束时,研究组与对照组相比,左房内径分别为(36±2.8)mm和(38.7±3.4)mm,P=0.008;左室内径分别为(46.7±4.5)mm和(49.4±5.2)mm,P=0.07,对照组的左心房、左心室较研究组相对增大。E波最大血流速度-时间积分分别为(13.2±0.9)和(9.9±1.7);A波最大血流速度-时间积分分别为(5.1±0.9)和(4.1±0.9);左心室射血分数分别为(58.6±2.2)%和(55.3±4.1)%;每搏量分别为(63±5.2)mL和(54.9±6.6)mL,对照组患者的心功能明显降低。结论:最佳房室间期起搏有利于患者的心功能,超声心动图是指导房室间期设置的简便而可靠手段。
Objective: To explore the method of setting and managing the optimal ATR. Methods: In the study group (n = 23) who underwent dual-chamber pacemaker placement due to a high degree or complete atrioventricular block, we optimized the atrioventricular interval by echocardiography. The control group (n = 21) Routine settings of atrioventricular period. Echocardiographic changes and the incidence of atrial fibrillation and heart failure were compared between the two groups at 1 week and 7 months after implantation of the pacemaker. Results: (1) The AVD was (138.7 ± 8.7) ms in the study group and (124.8 ± 0.8) ms in the control group (P <0.001). (2) There was no significant difference in echocardiographic parameters between the two groups 1 week after implantation of pacemaker. (3) At the end of follow-up, the left atrial diameter was (36 ± 2.8) mm and (38.7 ± 3.4) mm respectively in the study group and the control group, P = 0.008; the left ventricular diameter was (46.7 ± 4.5) mm and (49.4 ± 5.2) mm, P = 0.07. Compared with the study group, the left atrium and left ventricle of the control group increased relatively. (13.2 ± 0.9) and (9.9 ± 1.7), respectively; the maximum blood flow velocity-time integral of A wave was (5.1 ± 0.9) and (4.1 ± 0.9) respectively; the left ventricular ejection fraction The scores were (58.6 ± 2.2)% and (55.3 ± 4.1)% respectively. The stroke volume was (63 ± 5.2) mL and (54.9 ± 6.6) mL respectively. The cardiac function of patients in the control group was significantly lower. CONCLUSIONS: Optimal atrioventricular pacing is beneficial for patients with cardiac function. Echocardiography is a simple and reliable means of guiding the interventricular septum setting.