不同的起搏部位对复苏后自主循环恢复的影响(1)
DOI：10.3760/cma.j.issn.1671-0282.2014.07.017
作者单位：518172 广东省深圳，深圳市龙岗区人民医院急诊科
通信作者：谢江霞，Email：Doctoranna@126.com
【摘要】目的 比较右心室流出道室间隔部起搏与心尖部起搏对复苏后血流动力学和心血管事件的影响?方法 选择深圳市龙岗区人民医院2010年11月至2014年1月收治的76例患者，经心电监护或心电图证实院内心搏呼吸骤停，接受心肺复苏联合经静脉临时心脏起搏术?成功建立有效循环?年龄≥18岁?入选病例排除因各种疾病终末期?晚期肿瘤?自然死亡因素所致心搏呼吸停止者?随机对76例在急诊抢救单元的X线透视确定其起搏位置，根据起搏位置的不同分为右心室流出道室间隔部起搏组36例[男26例，女10例，年龄(57.31±16.65)岁]和心尖部起搏组40例[男22例，女18例，年龄(60.43±15.48)岁]?所有患者行心电图检查测量起搏后QRS波群时限，并在早期至中间阶段通过床边超声心动图检查左室射血分数(LVEF)?左室短轴缩短率(FS)；通过无创血流动力学监测泵功能指数心排量(CO)和心脏指数(CI)?并在自主循环恢复后早期至中间阶段记录两组心血管事件的发生?所有数据采用SPSS 13.0统计软件进行分析?结果 两组患者在年龄?性别?原发病构成比?心脏骤停到自主循环恢复时间?肾上腺素用量等方面差异无统计学意义(P>0.05)?在自主循环恢复的早期至中间阶段，与心尖部起搏组比较，右心室流出道室间隔部起搏组在LVEF?FS?CO?CI均升高(0.46±0.04)% vs.(0.44±0.05) %?(0.34±0.05) vs.(0.32±0.04)?(3.73±0.46)L/min vs.(3.47±0.46)L/min?(2.67±0.29)L/(min·m2) vs. (2.46±0.26)L/(min·m2) ， P<0.05 ；右心室流出道室间隔部起搏组QRS时限较心尖起搏组显著缩短(128.25±6.06)ms vs.(151.93±8.99)ms， P<0.05；房颤发生率明显下降，但心衰和新血栓事件差异无统计学意义(P>0.05)?结论 心肺复苏后自主循环早期右心室流出道室间隔部起搏有利于稳定血流动力学，减少房颤的发生?
, 百拇医药
【关键词】起搏器；心肺复苏；复苏后自主循环
The influence of restoration of spontaneous circulation in temporary different pacing sites Wang Hejin，Pan Ying，Xie Jiangxia. Department of Emergency Medicine，Longgang District People’s Hospital of Shenzhen，Shenzhen 518172，China
Corresponding author：Xie Jiangxia，Email：Doctoranna@126.com
【Abstract】Objective To observe the impact of different pacing sites in hemodynamic and cardiovascular events after restoration of spontaneous circulation. Methods A total of 76 patients with-in hospital cardiac arrest occurred from November 2010 to January 2014 were confirmed by electrionic device monitoring or electrocardiogram and they received cardiopulmonary resuscitation， and their ages were over 18 years. Patients with end-stage of various disease， malignancy and cardiac arrest due to incurable diseases or debility of physical conditions were excluded. The 76 patients were divided into two groups according to pacing site checked by X-ray fluoroscopy in emergency rescue unit： right ventriclular outflow trace pacing group[n=36， male 26 cases， female 10 cases， age(57.31±16.65)years]and right ventricular apex pacing group[n=40， 22 male cases and 18 female cases， age (60.43±15.48) years]. All patients’ QRS duration were measured by ECG after pacemaker implantition and left ventricular ejection fraction (LVEF)， left ventricular short axis reduced rate (FS) ， heart rate (HR)， cardiac index (CI) were tested by bedside echocardiography and non-invasive hemodynamic monitoring was used during the early to middle stage. All the hemodynamic variables and the cardiac events were observed after spontaneous circulation recovery. All the data were analyzed by SPSS version 13.0 statistical software. Results There were no significant differences in age， gender， the primary disease， the time from cardiac arrest to spontaneous circulation restoration and dosage of epinephrine(P>0.05). In comparison with right ventricular apex pacing group， LVEF， FS， HR， CI were higher in right ventriclular outflow trace pacing group[(0.46±0.04)% vs.(0.44 ±0.05)%， (0.34±0.05)vs.(0.32±0.04)， (0.04±0.46)L/min vs.(3.47±0.46)L/min， (0.46±0.29)L/(min·m2) vs.(2.46±0.26) L/(min·m2)， P < 0.05] and right ventriclular outflow trace pacing group had shorter QRS duration than right ventriclular apex pacing group[ (128.25±6.06)ms vs.(151.93±8.99) ms， P < 0.05]；fewer atrial fibrilation event was detected in right ventriclular outflow trace pacing group after restoration of spontaneous circulation than that in right ventricular apex pacing group . But incidences of cardiac failure and thrombus were not different between two groups(P > 0.05).Conclusions The right ventriclular outflow trace pacing resulted in better hemodynamic and fewer atrial fibrilation after restoration of spontaneous circulation., 百拇医药(王合金 潘莹 谢江霞)
作者单位：518172 广东省深圳，深圳市龙岗区人民医院急诊科
通信作者：谢江霞，Email：Doctoranna@126.com
【摘要】目的 比较右心室流出道室间隔部起搏与心尖部起搏对复苏后血流动力学和心血管事件的影响?方法 选择深圳市龙岗区人民医院2010年11月至2014年1月收治的76例患者，经心电监护或心电图证实院内心搏呼吸骤停，接受心肺复苏联合经静脉临时心脏起搏术?成功建立有效循环?年龄≥18岁?入选病例排除因各种疾病终末期?晚期肿瘤?自然死亡因素所致心搏呼吸停止者?随机对76例在急诊抢救单元的X线透视确定其起搏位置，根据起搏位置的不同分为右心室流出道室间隔部起搏组36例[男26例，女10例，年龄(57.31±16.65)岁]和心尖部起搏组40例[男22例，女18例，年龄(60.43±15.48)岁]?所有患者行心电图检查测量起搏后QRS波群时限，并在早期至中间阶段通过床边超声心动图检查左室射血分数(LVEF)?左室短轴缩短率(FS)；通过无创血流动力学监测泵功能指数心排量(CO)和心脏指数(CI)?并在自主循环恢复后早期至中间阶段记录两组心血管事件的发生?所有数据采用SPSS 13.0统计软件进行分析?结果 两组患者在年龄?性别?原发病构成比?心脏骤停到自主循环恢复时间?肾上腺素用量等方面差异无统计学意义(P>0.05)?在自主循环恢复的早期至中间阶段，与心尖部起搏组比较，右心室流出道室间隔部起搏组在LVEF?FS?CO?CI均升高(0.46±0.04)% vs.(0.44±0.05) %?(0.34±0.05) vs.(0.32±0.04)?(3.73±0.46)L/min vs.(3.47±0.46)L/min?(2.67±0.29)L/(min·m2) vs. (2.46±0.26)L/(min·m2) ， P<0.05 ；右心室流出道室间隔部起搏组QRS时限较心尖起搏组显著缩短(128.25±6.06)ms vs.(151.93±8.99)ms， P<0.05；房颤发生率明显下降，但心衰和新血栓事件差异无统计学意义(P>0.05)?结论 心肺复苏后自主循环早期右心室流出道室间隔部起搏有利于稳定血流动力学，减少房颤的发生?
, 百拇医药
【关键词】起搏器；心肺复苏；复苏后自主循环
The influence of restoration of spontaneous circulation in temporary different pacing sites Wang Hejin，Pan Ying，Xie Jiangxia. Department of Emergency Medicine，Longgang District People’s Hospital of Shenzhen，Shenzhen 518172，China
Corresponding author：Xie Jiangxia，Email：Doctoranna@126.com
【Abstract】Objective To observe the impact of different pacing sites in hemodynamic and cardiovascular events after restoration of spontaneous circulation. Methods A total of 76 patients with-in hospital cardiac arrest occurred from November 2010 to January 2014 were confirmed by electrionic device monitoring or electrocardiogram and they received cardiopulmonary resuscitation， and their ages were over 18 years. Patients with end-stage of various disease， malignancy and cardiac arrest due to incurable diseases or debility of physical conditions were excluded. The 76 patients were divided into two groups according to pacing site checked by X-ray fluoroscopy in emergency rescue unit： right ventriclular outflow trace pacing group[n=36， male 26 cases， female 10 cases， age(57.31±16.65)years]and right ventricular apex pacing group[n=40， 22 male cases and 18 female cases， age (60.43±15.48) years]. All patients’ QRS duration were measured by ECG after pacemaker implantition and left ventricular ejection fraction (LVEF)， left ventricular short axis reduced rate (FS) ， heart rate (HR)， cardiac index (CI) were tested by bedside echocardiography and non-invasive hemodynamic monitoring was used during the early to middle stage. All the hemodynamic variables and the cardiac events were observed after spontaneous circulation recovery. All the data were analyzed by SPSS version 13.0 statistical software. Results There were no significant differences in age， gender， the primary disease， the time from cardiac arrest to spontaneous circulation restoration and dosage of epinephrine(P>0.05). In comparison with right ventricular apex pacing group， LVEF， FS， HR， CI were higher in right ventriclular outflow trace pacing group[(0.46±0.04)% vs.(0.44 ±0.05)%， (0.34±0.05)vs.(0.32±0.04)， (0.04±0.46)L/min vs.(3.47±0.46)L/min， (0.46±0.29)L/(min·m2) vs.(2.46±0.26) L/(min·m2)， P < 0.05] and right ventriclular outflow trace pacing group had shorter QRS duration than right ventriclular apex pacing group[ (128.25±6.06)ms vs.(151.93±8.99) ms， P < 0.05]；fewer atrial fibrilation event was detected in right ventriclular outflow trace pacing group after restoration of spontaneous circulation than that in right ventricular apex pacing group . But incidences of cardiac failure and thrombus were not different between two groups(P > 0.05).Conclusions The right ventriclular outflow trace pacing resulted in better hemodynamic and fewer atrial fibrilation after restoration of spontaneous circulation., 百拇医药(王合金 潘莹 谢江霞)