右室心尖部起搏QRS波时限对心功能的影响  

Impact of paced QRS duration on heart function in patients with right ventricular apical pacing

作　　者：陆铭[1] 蔡振荣[1] 王志华[1] 庄晓华[1] 凌佳[1] 阚丽虹[1] 罗心平[2] 王静恩[1] 

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院心血管内科,201399 [2]复旦大学附属华山医院心血管内科,上海市200040

出　　处：《实用医学杂志》2014年第17期2768-2770,共3页The Journal of Practical Medicine

摘　　要：目的:观察右室心尖部起搏患者起搏QRS波时限(pQRSd)对心功能的影响。方法:将76例因Ⅲ度房室阻滞而安装起搏器的患者根据起搏QRS波时限把患者分为A组(pQRSd<190 ms,n=52)、B组(pQRSd≥190ms,n=24),术前及术后12、24个月检测血浆脑钠肽(BNP)及行心脏多普勒超声检查(LAD、LVEED、LVESD、LVEF),以心衰事件为终点事件,并进行比较。结果:术后12个月,与A组比较,B组LVEF明显降低(P<0.05),两组间LAD、LVEDD、LVESD、血BNP无明显差异,术后24个月,与A组比较,B组的LAD、LVSED、LVDED明显增高(P<0.05),血BNP明显增高(P<0.001),LVEF明显降低(P<0.001),整个随访期间,B组比A组心衰再入院率高,但差异无统计学意义。结论:右室心尖部pQRSd的延长可致心脏功能的受损。Objective To investigate the impact of paced QRS duration （pQRSd） on heart function inpatients with right ventricular apical pacing. Methods Seventy-six patients with Ⅲ° atrioventricular block receivedpacemaker treatment were enrolled and randomized into group A （pQRSd 〈 190 ms, n = 52） and group B （pQRSdI〉 190 ms, n = 24）. The concentration of brain natriuretic peptide （BNP）, parameters of left atrial diameter（LAD）, left ventricular ejection fracetion （LVEF）, left ventricular end diastolic diameter （LVEDD）, leftventricular end systolic dimension （LVEDD） were measured before operation, at 12 months and 24 months afterimplanting, respectively. The parameters of echocardiography assay, the concentration of BNP and the incidence ofheart failure event after implantation were compared between two groups. Results At 12 months after implanting,LVEF of the patients in the group B decreased significantly compared with that of group A （P 〈 0.05）. However, theechocardiography paramenters and the concentration of BNP were not significantly different between the two groups（P 〉 0.05）. At 24 months after implanting, LAD, LVEDD, LVESD of group B increased significantly compared withthose of group A [ LAD, （ 44.5 ± 6.2） mm vs （41.6 ± 5.1） mm, LVEDD, （52.7 ± 9.3） mm vs （48.2 ± 7.5） mm, LVESD,（37.5 ± 5.6） mm vs （33.8 ± 4.9）mm, each P 〈 0.05, respectively]. The concentration of BNP of group B increasedsignificantly [ （408.2 ± 102.1）ng/L vs （243.7 ± 92.8）ng/L, P 〈 0.001 ], and LVEF of the patients in group Bdecreased significantly compared with those of group A [ （46.3 ±6.8）% vs （51.6 ± 5.2）%, P 〈 0.001 ], respectively.No significant difference in the incidence of heart failure event （41.7% vs 26.9%, P 〉 0.05）between two groupsduring 24-month follow-up. Conclusion The prolonged paced QRS duration has a detrimental effect on long-termcardiac function during RVA pacing in patients with Ⅲ atrioventricular block.

关 键 词：心力衰竭 QRS波时限 右室起搏 脑钠肽 

分 类 号：R541.7[医药卫生—心血管疾病]