双腔起搏器最小化心室起搏策略对心力衰竭患者心功能的影响  

Effects of different strategies to minimize ventricular pacing on cardiac function in heart failure patients

作　　者：刘如辉[1] 蒋金法[1] 徐文俊[1] 许嘉鸿[1] 宋浩明[1] 方宏[1] 

机构地区：[1]同济大学附属同济医院心内科,上海200065

出　　处：《上海医学》2014年第8期691-693,共3页Shanghai Medical Journal

摘　　要：目的比较自动房室搜索(Search AV)和心室起搏管理(MVP)模式下,植入双腔起搏器(DDD起搏器)的心力衰竭患者的心功能变化。方法选取因病态窦房结综合征植入双腔起搏器的患者58例,随机分入Search AV组和MVP组,植入DDD起搏器后分别启用Search AV模式和MVP模式,随访12个月,比较两组心室起搏比例,以及植入前、植入后12个月的心功能指标和血浆N末端B型利钠肽原(NT-ProBNP)水平。结果 MVP组心室起搏比例为0.5%,显著低于Search AV组的4.2%(P<0.01);Search AV组植入后12个月的左心室射血分数、舒张早期的E峰与舒张晚期的A峰比值(E/A比值)均显著低于同组植入前(P值均<0.05),而MVP组植入前后的差异无统计学意义(P值均>0.05)。两组植入后12个月的NT-ProBNP水平均较同组植入前有升高趋势,但差异无统计学意义(P值均>0.05),Search AV组植入后12个月与植入前NT-ProBNP的差值显著高于MVP组(P<0.05)。结论对于病态窦房结综合征植入DDD起搏器的心力衰竭患者,右心室流出道起搏状态下,MVP模式对患者长期心脏收缩和舒张功能的影响小于Search AV模式。Objective To evaluate cardiac function in heart failure patients who received dual chamber pacemaker implantation through two algoritlTns; managed ventricular pacing （MVP） and search atria ventricle （Search AV）. Methods Permanent dual chamber pacemakers were implanted in 58 patients for sick sinus syndrome. The patients were randomly divided into MVP group and Search AV group, and MVP or Search AV algorithms were used accordingly after the pacemaker was implanted. The percentages of ventricular pacing, parameters of echocardiography and plasma N terminal B type natriuretic peptide（NT-ProBNP） were recorded before and 12 months after implantation. Results The percentages of ventricular pacing was significantly lower in MVP group than that in Search AV group （0.5% vs. 4.2%, P〈0.01）. The left ventricular ejection fraction （LVEF） and E/A ratio were significantly decreased in the Search AV group 12 months after implantation as compared with those before implantation （both P〈0.05）, while there were no significant differences in LVEF or E/A ratio in the MVP group before and after implantation （both P 〉0.05）. The plasma NT-ProBNP was increased in both groups after implantation, but there was no significant difference before and after implantation （both P〉0.05）. The plasma NT-ProBNP was increased significantly in the Search AV group as compared with MVP group （P〈0.05）. Conclusion MVP algorithm has less influence than Search AV algoritln on heart systolic and diastolic functions in heart failure patients undergoing dual chamber pacemaker implantation because of sick sinus syndrome. （Shanghai Med J, 2014, 37： 691-693）

关 键 词：心室起搏管理 自动房室搜索 心力衰竭 心功能 

分 类 号：R541.7[医药卫生—心血管疾病]