闭环刺激双腔起搏器防治血管迷走神经性晕厥的疗效观察  

Effect of dual-chamber closed-loop stimulation pacing in prevention of vasovagal syncope

作　　者：萧钟波[1] 孟素荣[1] 邹云新[1] 赵冬华[1] 刘福强[1] 李岩[1] 彭健[1] 

机构地区：[1]南方医科大学附属南方医院心内科,广东广州510515

出　　处：《心脏杂志》2013年第1期43-46,50,共5页Chinese Heart Journal

基　　金：广东省科技计划项目资助(2010B031600242)

摘　　要：目的：观察植入闭环刺激双腔起搏器防治血管迷走神经性晕厥（VVS）的效果。方法：将40例经直立倾斜试验确诊为VVS且近期多次发作的患者,分为起搏器组（18例）和药物治疗组（22例）,所有患者均给予口服美托洛尔缓释片（4715mg,1次/d）,起搏器组植入具有闭环刺激功能（CLS）的双腔起搏器,药物治疗组不做其他治疗,两组患者治疗3个月后复查直立倾斜试验并随访观察。结果：起搏器组直立倾斜试验转阴率94%,药物治疗组直立倾斜试验转阴率29%,两组比较差异有统计学意义（P〈0101）。两组患者随访观察6～21（13±5）个月,起搏器组所有患者均未再发晕厥,2例有晕厥先兆,但症状较前明显减轻;药物治疗组9例再发晕厥,但发作次数较前减少。两组患者间晕厥复发率差异有统计学意义（P〈0101）。结论：具有闭环刺激功能双腔起搏器能有效的防治血管迷走神经性晕厥。AIM： To investigate the effect of dual-chamber pacing in the prevention of vasovagal syncope. METHODS： Forty patients with vasovagal syncope who were confirmed by positive head-up tilt table testing （HUTY） and had recent recurrent vasovagal syncope were randomly divided into pacemaker group （ n = 18 ） and pharmacotherapy group （n = 22）. All patients were orally administered metoprolol tablets （47. 5 rag, qd）. The patients in the pacemaker group were implanted with dual-chamber closed-loop stimulation （CIS） pacing, whereas patients in the pharmacotherapy group received no other treatment. Patients in both groups were examined again with HUTF 3 months after treatment and were followed up. RESULTS： The posi- tive to negative rate of HUT was 94% in the pacemaker group and 29% in the pharmaeotherapy group, with statistically significant differences between groups （P 〈0. 01 ）. During the follow-up [mean （13 ±5） months, range： 6 -21 months] , no patients in the pacemaker group had syncope, although two patients still had significantly alleviated syncope precursory symptoms and signs. Nine patients in the pharmaeotherapy group had recurrent syncope, but with fewer attacks. A statistically significant difference was observed in the occurrence of syncope between groups （P 〈 0. 01 ）. CONCLUSION： Dual-chamber CLS pacing can prevent the occurrence of syncope in patients with vasovagal syncope.

关 键 词：闭环刺激 心脏起搏 晕厥 血管迷走神经性 

分 类 号：R364.14[医药卫生—病理学]