不同起搏模式对老年患者B型钠尿肽及相关神经内分泌激素水平的影响  

Effect of different pacing modes on BNP and neuroendocrine hormone levels in elderly patients

作　　者：马建新 陈东 宋成运 李运田 马建慧[2] 

机构地区：[1]解放军305医院心血管中心,北京100017 [2]新疆石河子大学药学院

出　　处：《中华老年心脑血管病杂志》2013年第6期563-565,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都医学发展科研基金(2009-3060)

摘　　要：目的观察置入具有工作模式转换功能的双腔起搏器术后心室起搏百分比与血浆B型钠尿肽(BNP)及相关神经内分泌激素水平的关系。方法选择置入双腔起搏器的老年患者22例,分为A组11例,D组11例。采用自身前后对照研究方法,观察同一患者在心房按需型起搏(AAI)SafeR和房室全能型起搏(DDD)2种工作模式下的心室起搏百分比,检测患者血浆BNP、肾素活性、血管紧张素Ⅱ、醛固酮水平,并分析两者之间的关系。结果与术前比较,所有患者术后血浆BNP水平明显升高(P<0.05)。与AAISafeR模式比较,A组、D组DDD模式时患者血浆BNP水平明显升高(P<0.05)。与DDD模式比较,AAISafeR模式下心室感知百分比明显增加[(73.18±13.08)%vs(34.69±9.02)%,P<0.05],心室起搏百分比明显减少[(23.11±7.05)%vs(73.24±11.38)%,P<0.05]。相关分析显示,心室起搏百分比与血浆BNP水平呈正相关(r=0.158,P<0.01)。结论 AAISafeR模式可有效减少心室起搏百分比,心室起搏可能产生起搏依赖性的心功能损害。Objective To study the relation between cumulative percent of ventricular pacing （Cum%VP） and plasma levels of BNP and neuroendocrine hormones in elderly patients after im- plantation of double-chamber pacemaker with pace mode converting function. Methods Twenty- two elderly patients after pacemaker implantation were divided into group A and group B （llin each group）. The Cum%VP was measured for the patients before and after the pacemaker implan- tation in two pacing modes （DDD and AAISafeR）. Plasma levels of BNP and rennin,angiotensin Ⅱ ,aldosterone were measured and their relation was analyzed. Results The plasma BNP level was significantly higher in all patients after pacemaker implantation than before pacemaker im- plantation and in DDD pacing mode than in AAISafeR pacing mode （P〈0.05）. The Cum% of ventricular sensing was significantly higher whereas the Cum%VP was significantly lower after pacemaker implantation in the AAISafeR pacing mode than in the DDD pacing mode （73.18% ±13.08% vs 34.69%±9.02%,P〈0.05;23.11%±7.05%vs 73.24%± 11.38%,P〈0.05）. Cor- relation analysis showed that the Cum%VP was positively correlated with the plasma BNP level （r=0. 158,P〈0.01）. Conclusion The AAISafeR pacing mode can effectively reduce the Cum% VP and ventricular pacing can impair the pacing-dependent heart function.

关 键 词：心脏起搏 人工 利钠肽 脑 血管紧张素Ⅱ 神经分泌系统 醛固酮 

分 类 号：R541.7[医药卫生—心血管疾病]