右室流出道间隔部置入起搏器对患者生活质量的影响  

Quality of life in patients with bradyarrhythmia following right ventricular outflow tract septa pacing therapy

作　　者：林纯莹[1] 陈泗林[1] 蔡清媚[1] 古良[1] 刘烈[1] 陈东骊[1] 梁远红[1] 费洪文[2] 

机构地区：[1]广东省人民医院心血管病研究所心内科,广东省广州市510100 [2]广东省人民医院心血管病研究所B超室,广东省广州市510100

出　　处：《中国组织工程研究与临床康复》2008年第30期5907-5910,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省重点攻关项目(2006B36007014);广东省医学科研基金(A2007047);广东省自然科学基金(7001120)~~

摘　　要：背景:已有随机对照研究显示右室流出道间隔部起搏对左室同步性及心功能恢复明显优于右室心尖部起搏。但右室流出道间隔部起搏对生活质量的影响国内尚未见报道。目的:应用SF-36量表和超声心动图方法来评估右室流出道间隔部起搏对缓慢性心律失常患者生活质量的影响。设计、时间及地点:病例分析,2005-06/2007-09在广东省心血管病研究所进行。对象:缓慢心律失常患者60例,其中男29例,女31例;年龄(62±18)岁。方法:采用锁骨下静脉穿刺方法置入DDD(R)起搏器,心室电极采用主动固定电极置入于右室流出道间隔部,于置入前和置入后12个月用SF-36量表及超声心动图评估患者生活质量和症状度。主要观察指标:①起搏器置入及起搏参数变化。②生活质量评分变化。③超声心动图评价血流动力学指标变化。结果:全部患者未出现置入并发症,随访12个月无电极移位、阈值增高;右室流出道间隔部起搏治疗12个月躯体功能、躯体角色、肌体疼痛、社会功能、生命力、心理健康和总的健康状况方面高于置入前(P均<0.01),而情感角色的变化则没有统计学意义(P=0.125);左室舒张末径、左室收缩末内径、左室射血分数和左室充盈时间高于置入前(P均<0.01),Tei指数明显低于置入前(P<0.01)。结论:对缓慢心律失常患者,右室流出道间隔部起搏治疗能明显改善患者的症状、生活质量和血流动力学指标,未出现置入并发症。BACKGROUND： Randomized control studies have demonstrated that right ventricular outflow tract septa （RVOT） pacing exhibits superior efficacy on left ventricular synchrony and heart function recovery over right ventricular apex pacing. However, the influence of right ventricular outflow tract septa pacing on quality of life （QOL） is not reported in China. OBJECTIVE： To investigate the effects of RVOT pacing therapy on QOL in patients with bradyarrhythmia. DESIGN, TIME AND SETTING： Case analysis was performed at Guangdong Cardiovascular Institute between June 2005 and September 2007. PARTICIPANTS： Sixty patients with bradyarrhythmia, 29 males and 31 females aged （62±18） years were enrolled. METHODS： DDD （R） pacemaker was implanted using subclavian vein puncture method. Active fixation electrode was implanted into RVOT septa. QOL was assessed by 36-item Short Form Health Survey （SF-36） and echocardiogram at baseline and 12-month after RVOT pacing therapy. MAIN OUTCOME MEASURES： Pacemaker implantation and pacing parameter changes; QOL scores; hemodynamics using echocardiogram. RESULTS： Complications of implantation were not found in any patient. During a mean follow-up of 12 months, no electrode dislocation or threshold increase occurred; the scores of physical function, physical role, social function, bodily pain, mental health, vitality and general health were significantly ameliorated （P 〈 0.01）, while no significant differences were found in emotional role （P =0.125）; left ventricular end diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, and left ventricular diastolic filling time were significantly increased compared to before implantation （P 〈 0.01） but Tei index was significantly decreased （P 〈 0.01）. CONCLUSION： The symptoms, hemodynamics and QOL in patients with bradyarrhythmia are significantly improved by RVOT pacing with no complications following implantation.

关 键 词：右室流出道间隔部 起搏 生活质量 

分 类 号：R163[医药卫生—公共卫生与预防医学]