Lehmann Andreas, Lang Johannes, Thaler Elfi, Zeitler Christine, Weisse Udo, Boldt Joachim
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
J Cardiothorac Vasc Anesth. 2002 Apr;16(2):175-9. doi: 10.1053/jcan.2002.31059.
To compare hemodynamics and oxygenation in patients with congestive heart failure and broad QRS complexes before and with biventricular DDD pacing and to report experience with this new procedure.
Prospective, observational study.
Major university-affiliated community hospital.
Ten patients with congestive heart failure (New York Heart Association III to IV) and broad QRS complexes (>160 msec).
Patients underwent implantation of a biventricular pacemaker (n = 4) or implantation of a combined biventricular pacemaker and cardioverter-defibrillator (n = 6). Anesthesia was performed using remifentanil (0.2 to 0.3 microg/kg/min) and propofol. Propofol was used as target-controlled infusion (plasma target concentration, 1.5 to 2.5 microg/mL).
Hemodynamics and oxygenation were measured before and with biventricular DDD pacing. Mean arterial pressure was significantly increased from 64.7 +/- 5.8 mmHg to 77.8 +/- 10.6 mmHg by biventricular pacing, whereas cardiac index (2.2 +/- 0.3 L/min/m(2) before and 2.3 +/- 0.3 L/min/m(2) with biventricular pacing) and pulmonary capillary wedge pressure (12.1 +/- 3.8 mmHg before and 14.2 +/- 3.6 mmHg with biventricular pacing) remained unchanged. Left ventricular stroke work index was increased >10% in 7 patients. Oxygen delivery, oxygen consumption, and difference in arteriovenous oxygen concentration were not affected. Anesthesia with remifentanil and propofol was safe and well-controllable and allowed immediate extubation at the end of the operation.
There was no acute intraoperative improvement of hemodynamics except increased mean arterial pressure with biventricular pacing. Left ventricular performance seemed to improve with biventricular pacing in some patients. These results might be due to a nonoptimized atrioventricular delay. Postoperatively, atrioventricular delay was individually programmed for each patient by Doppler transmitral flow patterns.
比较充血性心力衰竭且QRS波群增宽患者在双心室DDD起搏前后的血流动力学和氧合情况，并报告这一新技术的应用经验。
前瞻性观察研究。
大型大学附属医院。
10例充血性心力衰竭（纽约心脏协会心功能Ⅲ至Ⅳ级）且QRS波群增宽（>160毫秒）的患者。
患者接受双心室起搏器植入（n = 4）或双心室起搏器与心脏复律除颤器联合植入（n = 6）。采用瑞芬太尼（0.2至0.3微克/千克/分钟）和丙泊酚进行麻醉。丙泊酚采用靶控输注（血浆靶浓度，1.5至2.5微克/毫升）。
在双心室DDD起搏前后测量血流动力学和氧合情况。双心室起搏使平均动脉压从64.7±5.8毫米汞柱显著升至77.8±10.6毫米汞柱，而心脏指数（双心室起搏前2.2±0.3升/分钟/平方米，双心室起搏时2.3±0.3升/分钟/平方米）和肺毛细血管楔压（双心室起搏前12.1±3.8毫米汞柱，双心室起搏时14.2±3.6毫米汞柱）保持不变。7例患者的左心室每搏功指数增加>10%。氧输送、氧消耗及动静脉氧浓度差值未受影响。瑞芬太尼和丙泊酚麻醉安全且可控，手术结束时可立即拔管。
除双心室起搏使平均动脉压升高外，术中血流动力学无急性改善。部分患者双心室起搏似乎可改善左心室功能。这些结果可能归因于房室延迟未优化。术后，根据每位患者的二尖瓣血流频谱对房室延迟进行个体化程控。
