右室心尖部起搏对完全性房室传导阻滞高龄患者心功能的影响  

The effect of right ventricular apex pacing on heart function in aged patients with complete atrioventricular block

作　　者：程源[1] 王邦宁[1] 

机构地区：[1]安徽医科大学第一附属医院心内科,合肥230022

出　　处：《中国临床保健杂志》2010年第2期156-157,共2页Chinese Journal of Clinical Healthcare

基　　金：安徽省卫生厅医学科研课题资助项目(09A054)

摘　　要：目的探讨心脏永久起搏器在心功能基本正常的高龄患者中的应用,评价右室心尖部(RVA)起搏对高龄患者心功能的影响。方法43例年龄≥75岁的完全性房室传导阻滞患者分为两组,VVI型起搏器23例,DDD型起搏器20例,心房电极置于右心耳,心室电极置于右室心尖部。术后平均随访12个月,了解患者自觉症状、运动耐量(6min步行距离试验)、起搏器功能情况及左室射血分数(LVEF)和脑利尿钠肽(BNP)水平。结果所有患者随访期间起搏器功能正常,新发生心房颤动5例;与术前相比,术后6分钟步行距离有改善[(368.58±65.74)mvs(377.47±57.72)m,P<0.01],LVEF无改变[(52.05±4.71)%vs(51.86±4.77)%,P>0.05],血浆BNP升高[(234.93±151.86)ng/Lvs(262.07±122.53)ng/L,P<0.05];术后随访期间,6分钟步行距离、LVEF和全血BNP,VVI组和DDD组相比无差别。结论高龄患者完全RVA起搏改善症状,未观察到加重心功能损害状况。Objective To investigate the application of permanent cardiac pacing in aged patients with normal heart function,and to evaluate the effects of complete right ventricular apex（RVA）pacing on heart function of aged patients.Methods A total of 43 patients（age≥73 years old）with complete atrilventricular block were enrolled and were randomized into two different cardiac pacing mode of VVI（n=23）and DDD（n=20）,atrial leads were placed in right auricular appendage,ventricular leads were placed in RVA.During the average 12 months of follow-up,we investigate patients’ symptome,exercise tolerance（6 minutes walking-distance test）、the state of pacemakers,the ejection fraction of left ventricular（LVEF）and the level of brain natriuretic peptide（BNP）.Results The state of pacemakers was all right during follow-up,atrial fibrillation happened in 5 patients.Compared to pre-operative,6 minutes walking-distance improved（368.58±65.74 meters vs 377.47±57.72 meters,P0.01）,there were no significant difference in LVEF（52.05±4.71% vs 51.86±4.77%,P0.05）,the blood plasma level of BNP increased（234.93±151.86ng/L vs 262.07±122.53ng/L,P0.05）.During the follow-up time,there was no significant difference in these items in the two groups.Conclusion Complete RVA pacing can improve some symptom in aged patients,however,it is possible to impair heart function.

关 键 词：房室传导阻滞 心脏起搏器 人工 利钠肽脑 心脏功能试验 老年人 

分 类 号：R541.7[医药卫生—心血管疾病]