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目的依据心脏超声对右室起搏电极的定位,分析各部位起搏的影像及12导联心电图特点,以协助提高间隔定位的准确率。方法对100例在本院行双腔起搏器安置术的患者,依据超声定位分为4组:右室流出道(ROVT)间隔部、ROVT前壁、中间隔部及前间隔部(间隔与前壁夹角),记录4组患者左前斜45°(LAO 45°)图像中电极头端平行线与水平线夹角、左侧位(LL)图像中电极头端方向、正位(PA)图像中以0.1个椎体为单位记录电极头端在平静吸气末距心底影的椎体个数及术后心室充分起搏的心电图中Ⅱ导联QRS波时限、心电轴、Ⅱ导联R波振幅、Ⅰ导联的形态、Ⅲ导联形态、下壁导联切迹、胸前移行导联。分析各部位影像及心电图指标特点。结果 1LAO 45°时,ROVT前壁及前间隔部电极头段与水平线夹角显著大于ROVT间隔部及中间隔部,受试者工作曲线(ROC)显示夹角=56.0°时灵敏度和特异度最大。2LL时,ROVT间隔部及中间隔部电极指向脊柱比例显著大于ROVT前壁及前间隔部。3PA时,ROVT前壁及ROVT间隔部电极高度明显高于中间隔部及前间隔部,电极头端距心底影的椎体个数=1.75时,灵敏度和特异度最大。4ROVT前壁及前间隔部起搏QRS波时限、下壁导联存在切迹比例显著大于ROVT间隔部及中间隔部。ROC曲线显示当起搏QRS波时限=150ms时,区分间隔与前壁的灵敏度和特异度最大,联合LAO 45°电极头段与水平线夹角及起搏QRS波时限,可提高间隔定位的灵敏度及特异度,分别为94%及80%。结论右室不同部位起搏在术中影像及心电图上分别表现出一定特点,对间隔定位有协助作用。
Objective According to the location of right ventricular pacing electrode by echocardiography, the images of pacing and the characteristics of 12-lead electrocardiogram were analyzed to help improve the accuracy of interval positioning. Methods A total of 100 patients undergoing double-chamber pacemaker placement in our hospital were divided into 4 groups based on ultrasound localization: the right ventricular outflow tract (ROVT), the anterior wall of the ROVT, the medial septum, and the anterior septum The angle between the horizontal line and the parallel line of the electrode tip in the left anterior oblique 45 ° (LAO 45 °) image, the direction of the tip of the electrode in the left lateral (LL) image, the anteroposterior (PA) image In 0.1 vertebral body as the unit record in the end of the first tranquilum at the end of the inspiratory end of the vertebral body and the number of postsynaptic ventricular pacing after ECG Ⅱ lead QRS wave limit, ECG axis, Ⅱ Lead R Wave amplitude, the shape of lead Ⅰ, the lead shape of lead Ⅲ, the notch of lead of inferior wall, the lead of chest lead. Analysis of various parts of the imaging and ECG characteristics. Results When the angle of 45 ° was 1LAO, the angle between the tip of the ROVT anterior wall and the anterior segment was significantly larger than that of the ROVT and middle septum. The receiver operating curve (ROC) showed the highest sensitivity and specificity at the angle of 56.0 ° . 2LL, ROVT spacer and middle spacer electrodes pointed to the spine significantly larger than the ROVT front wall and the front spacer. 3PA, ROVT anterior wall and ROVT interval electrode height was significantly higher than the middle septum and anterior septum, the tip of the end of the fundus of the vertebral body when the number = 1.75, the sensitivity and specificity of the largest. 4ROVT anterior wall and anteroseptal pacing QRS wave duration, there is a notch lead ratio lower wall leads significantly larger than the ROVT interval and the middle part. The ROC curve showed that the sensitivity and specificity of distinguishing interval from the anterior wall were maximal when the QRS wave limit of pacing was 150ms and the sensitivity of LAA 45 ° and horizontal QRS wavefront were the best. Specificity was 94% and 80% respectively. Conclusion Pacing of different parts of the right ventricle shows certain characteristics respectively in the intraoperative imaging and electrocardiogram, which can assist in the positioning of the space.