右室间隔部起搏对心功能影响的Meta分析  

A Meta analysis on influence of right ventricular septum pacing on heart function

作　　者：张宇龙[1] 白锋[1] 张小卫[1] 潘慧[2] 郭继武[2] 吴佳[2] 刘凌[3] 

机构地区：[1]兰州大学第二医院,兰州730000 [2]兰州大学第二临床医学院 [3]兰州大学第一临床医院学院

出　　处：《中国循证心血管医学杂志》2011年第4期260-267,共8页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家大学生创新性实验计划项目基金(091073049)

摘　　要：目的系统评价右室间隔部(RVS)起搏对心功能的影响。方法计算机检索Cochrane图书馆(2010年第1期)、PubMed、EMbase,同时检索CBM、CNKI、VIP和万方数据库,检索时间截至2010年3月,收集右室间隔部(RVS)起搏对比右室心尖部(RVA)起搏对心功能影响的随机对照试验(RCT),并按Cochrane协作网推荐的方法进行质量评价、资料提取和Meta分析。结果共纳入35个RCT,包括2034例患者。Meta分析结果显示:①左室射血分数:RVS起搏在3个月和18个月的左室射血分数均高于RVA起搏,差异有统计学意义[WMD=3.53,95%CI:1.02～6.04];[WMD=7.44,95%CI:5.46～9.42]。②QRS波时限:RVS起搏在术后即时和3个月的QRS波时限均小于RVA起搏,差异有统计学意义[WMD=-27.7,95%CI:-34.24～-21.15];[WMD=-17.02,95%CI:-24.14～-9.90]。③起搏参数:术后3个月时RVS起搏的起搏阈值与RVA起搏无差别。RVS起搏的感知阈值和阻抗均低于RVA起搏。结论右室间隔部起搏能给患者带来良好的近生理状态的双心室电传导,并改善患者的血流动力学,右室间隔部有望成为首选的心室起搏部位。Objective To review systematically the influence of right ventricular septum（RVS） pacing on heart function.Methods The literature of randomized and controlled trials（RCT） about the influence of RVS pacing,compared with that of right ventricular apex（RVA） pacing,on heart function were retrieved with computer from Cochrane Library（the first issue of 2010）,PubMed,EMbase,CBM,CNKI,VIP and WANGFANG DATA（by March,2010）.All data was given quality review,material extraction and Meta analysis by using the methods recommended by the Cochrane Collaboration.Results There were 35 RCT enclosed including 2034 patients.The results of Meta analysis showed：①the left ventricular ejection fraction（LVEF）：LVEF was higher in the RVS pacing than that in the RVA pacing on the 3rd month and the 18th month,and the difference was statistically significant[WMD=3.53,95% CI：1.02~6.04]and[WMD=7.44,95% CI：5.46~9.42].②QRS wave duration：QRS wave duration was lower in the RVS group than that in the RVA group immediately or 3 months after the operation,and the difference was statistically significant[WMD=-27.7,95% CI：-34.24^-21.15]and[WMD=-17.02,95% CI：-24.14^-9.90].③pacing parameter：after the operation for 3 months,the pacing threshold had no difference between the RVS pacing and RVA pacing.The sensing threshold and impedance were lower in the RVS group than those in the RVA group.Conclusion The right ventricular septum pacing can lead a good bi／｜ventricular conduction near physiological condition,and improve the hemodynamics.The right ventricular septum is expected to be a preferred site of ventricular pacing.

关 键 词：右室间隔部 右室心尖部 起搏 META分析 

分 类 号：R541.61[医药卫生—心血管疾病]