右室心尖部起搏对老年患者心功能的影响  

Impacts of right ventricular apical pacing on heart function in the eldy

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：《临床心血管病杂志》2010年第5期343-345,共3页Journal of Clinical Cardiology

基　　金：安徽省卫生厅医学科研课题资助项目(No:09A054)

摘　　要：目的：评价右室心尖部起搏对老年患者心脏功能的影响。方法：入选因缓慢性心律失常安装心脏永久起搏器的老年患者（年龄≥60岁）115例。所有患者均为心房电极位于右心耳,心室电极置于右室心尖部;VVI型起搏器60例,DDD型起搏器55例。按最终心室累积起搏百分比（Cum%VP）分为3组：A组Cum%VP〈50%（34例）,B组Cum%VP≥50%～〈100%（38例）,C组为完全心室起搏,即Cum%VP=100%（43例）。通过询问患者自觉症状,行运动耐量、左室射血分数（LVEF）及脑利钠肽（BNP）水平的检查,了解各组及不同起搏模式患者术前、后心功能的变化。结果：①术后18个月,与术前比较,3组均有心功能恶化趋势,即LVEF、BNP均有降低、升高的改变,但A组的改变幅度最小,C组的改变幅度最大,B组介于两者之间;②VVI与DDD起搏相比,对心功能的影响无差异,VVI起搏患者心房颤动和脑栓塞发生率略高。结论：①老年患者在右室心尖部起搏情况下,随着Cum%VP的增加,心功能恶化程度增大;②VVI或DDD起搏模式不是影响老年患者心功能的决定因素。Objective：To evaluate the impacts of right ventricular apical（RVA） pacing on heart function in the eldy.Method：A total of 115 patients（≥60 years old） received permanent cardiac pacemaker for bradyarrhythmias were enrolled.Two different cardiac pacing mode of VVI（n=60） and DDD（n=55） were performed.Atrial leads were placed at right auricular appendage,ventricular leads were placed at RVA.According to the final cumulative percentage of ventricular pacing（Cum%VP）,the subjects were divided into three groups.Group A： Cum%VP〈50%（n=34）,Group B： Cum%VP≥50%-〈100%（n=38）,Group C： Cum%VP=100%（n=43）.we investigated patients＇ symptome,exercise tolerance,ejection fraction of left ventricular（LVEF） and the concentration of brain natriuretic peptide（BNP） to compare heart functon preoperative and postoperative of patients in each group and different pacing mode.Result：①At 18 months after operation,each group had a trend of aggravation in heart function compared with preoperative,that means decrease in LVEF and increase in BNP.But group A changed least and group C changed most,group B fell in between.②Different pacing mode of VVI and DDD had similar effect on heart function,the incidence of atrial fibrillation and cerebral embolism was a little higher in VVI group.Conclusion：①Under the circumstance of RVA pacing,the deterioration of heart function increase with Cum%VP;②Pacing mode of VVI or DDD is not the determinative factor of heart function.

关 键 词：起搏 心功能 老年 

分 类 号：R318.11[医药卫生—生物医学工程]