临时心脏起搏器对心肺复苏后新发心房颤动的影响  

Influence of temporary pacemaker on new atrial fibrillation after cardiopulmonary resuscitation

作　　者：潘莹[1] 黄站军 段雯[1] 曾宪钦[1] 张志远[1] 

机构地区：[1]深圳市龙岗区人民医院,深圳518172

出　　处：《新医学》2014年第11期754-757,共4页Journal of New Medicine

摘　　要：目的探讨临时起搏器对心肺复苏后出现新发心房颤动的影响。方法回顾成功心肺复苏后出现长RR间期并行临时心脏起搏术患者106例,根据长RR间期的心电图表现分为起搏点异常组50例和传导阻滞组56例,然后又根据起搏部位不同分为心尖部起搏组和右心室流出道起搏组。所有患者起搏模式均为VVI起搏。观测7 d分析心房颤动发生情况。结果心房颤动总发生率为17.0%(18/106),起搏点异常组30例行心尖部起搏,心房颤动发生率为36.7%(11/30),20例行右心室流出道起搏,心房颤动发生率为5%(1/20)。心尖起搏组心房颤动发生率高于右心室流出道起搏组(36.7%vs.5%,P<0.05);传导阻滞组32例行心尖部起搏,心房颤动发生率为18.8%(6/32),24例行右心室流出道起搏,心房颤动发生率为0%(0/24),心尖起搏组心房颤动发生率高于右心室流出道起搏组(18.8%vs.0%,P<0.05)。通过Logistic回归分析后,心房颤动发生与右心室心尖起搏相关。结论心肺复苏后无论是起搏点异常还是传导异常行临时起搏器治疗,右心室流出道起搏有利于减少心房颤动的发生。Objective To discuss the effect of temporary pacemaker upon the incidence of atrial fi- brillation （AF） after cardiopulmonary resuscitation （CPR）. Methods A total of 106 patients who presented with long RR interval after successful CPR and then accepted temporary pacemaker therapy at our institution were retrospectively analyzed. According to ECG characteristics of the long RR interval, 106 patients were di- vided into the abnormal pacing site （n = 50） and conduction block groups （n --56）. Based on pacing site, all patients were assigned into the right ventricular （RV） apical pacing and right ventricular out flow tract pacing groups. The pacing mode in all patients was VVI. During 7 day-observation, the AF after CPR was analyzed. Results The total incidence of AF was 17.0% （18/106）. As to abnormal pacing site group, the incidence of AF in patients undergoing apex pacing was 36. 7% （ 11/30）, which was significantly higher compared with 5% （1/20） for those receiving right ventricular out flow tract pacing （P 〈0. 05）. In the conduction block group, the incidence of AF was 18. 8% （6/32） in patients receiving apex pacing, significantly higher compared with 0% （0/24） in those undergoing right ventricular out flow tract pacing （P 〈 0. 05 ）. Logistic regression analysis revealed that the incidence of AF was correlated with apex pacing. Conclusions For patients with temporary pacemaker either due to abnormal pacing site or conduction block, right ventricular outflow tract pacing is help- ful to reduce the incidence of AF.

关 键 词：起搏器 心肺复苏 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]