D-二聚体水平监测在起搏器植入术中的价值  

Value of D-dimer levels in patients with pacemaker implantation

作　　者：朱业[1] 顾翔[1] 孙磊[1] 张薏[1] 鲍正宇[1] 

机构地区：[1]江苏省苏北人民医院心血管内科,扬州225001

出　　处：《中华心律失常学杂志》2013年第2期130-133,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：基金项目：江苏省医学重点人才基金资助（JS2006038）

摘　　要：目的通过监测植入起搏器患者D-二聚体水平，比较单腔、双腔和三腔（心脏再同步治疗，CRT）起搏器植入对静脉血栓形成和栓塞影响程度，以减少静脉栓塞并发症的发生。方法随机选取2010年6月-2011年6月在江苏省苏北人民医院植入起搏器患者80例，根据起搏模式分为VVI、DDD、CRT起搏器3组，分别于术前2d，术后24h、7d监测D-二聚体水平。所有患者随访至少1年，随访期间定期监测D-二聚体水平。结果3组患者植入起搏器后24hD-二聚体水平较术前均增高，差异有统计学意义（P=0．029，0．026，0．003）；术后7d，DDD、CRT起搏器组患者的D-二聚体水平较术前均增高，差异有统计学意义（P=0．023，0．020）；CRT起搏器组患者术后24hD-二聚体水平较VVI、DDD起搏器组增高，差异有统计学意义（（3．76±2．68）μg／ml对（2．59±2．13）μg／ml，P=0．028；（3．76±2．68）μg／ml对（1．46±0．74）μg/ml，P=0．010]。随访期间共发生2例血栓事件。结论起搏器植入可以导致机体凝血和纤溶系统的激活，通过监测D-二聚体水平，发现CRT植人术后D-二聚体水平明显高于普通起搏器。能否通过监测D-二聚体水平，判断患者凝血状态、预防血栓形成的发生，还需进一步的临床研究和证据。Objective Venous lesions,including obstruction and thromboembolism （ VTE）, were common after pacemaker implantation. This study was arm to assess the effects of various permanent transvenous pacemakers on serum levels of D-dimer（ D-D）, including single-chamber, dual-chamber and cardiac resynchronization therapy（ CRT） devices and reduce complications of venous thrombosis. Methods Eighty patients with pacemaker implantations were enrolled in this study according to the mode of pacing. The blood samples were harvested before implantation,24 hours and 7 days after implantation, respectively. Results Compared with the levels of D-D preimplantation, the levels of D-D in all the groups increased significantly after implantation （P = 0. 029,0. 026,0. 003 ）. Compared with the levels of D-D preimplantation, the levels of D-D in patients with CRT and dual-chamber group increased significantly 7 days after implantation （ P = 0. 023,0. 020 ）. Compared with the levels of D-D in patients with single and dual-chamber,the levels of D-D in patients with CRT elevated significantly 24 hours after implantation[ （3.76±2. 68 ） μg/ml vs （2. 59 ± 2. 13 ） μg/ml, P = 0. 028; （3.76 ±2. 68 ） μg/ml vs （1.46 ± 0. 74）μg/ml, P = 0.010 ]. During the follow-up, there were two patients had thrombus. Conclusions Permanent transvenous pacemakers can lead to underlying abnormalities in the coagulation-fibrinolysis system. The levels of D-D in patients with CRT were increased remarkably after implantation.

关 键 词：起搏器 心律失常 D-二聚体 

分 类 号：R541[医药卫生—心血管疾病]