术前高同型半胱氨酸血症对心脏右心室心尖部起搏患者左心室收缩功能的影响  

Influence of preoperative high homocysteine on left ventricular systolic function in patients receiving right ventricular apical pacing

作　　者：潘广杰[1] 郑卫峰[1] 张守彦[1] 

机构地区：[1]郑州大学附属洛阳中心医院心内科,河南洛阳471000

出　　处：《中华实用诊断与治疗杂志》2015年第7期695-697,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨术前血浆高同型半胱氨酸对右心室心尖部起搏患者左心室收缩功能的影响。方法 病态窦房结综合征致Ⅲ度房室传导阻滞行植入双腔全自动心脏永久起搏器或单腔同步型起搏器患者100例,术前检测血浆同型半胱氨酸（homocysteine,Hcy）水平,按Hcy水平不同将患者分为观察组60例（Hcy≥10μmol/L）和对照组40例（Hcy〈10μmol/L）。观察2组术后7d及术后1a时左室射血分数（left ventricular ejection fraction,LVEF）、起搏器心律心电图QRS波群时限（pacemaker rhythm electrocardiogram QRS duration,PQRSD）及血浆脑钠肽（brain natriuretic peptide,BNP）水平,记录术后1a心功能不全发生率。结果观察组术后即刻PQRSD[（131.52±6.24）ms]、血浆BNP[（107.15±25.10）ng/L]及术后7dLVEF[（49.60±7.30）%]与对照组[（133.40±7.66）ms、（73.88±12.09）ng/L、（51.80±7.90）%]比较差异均无统计学意义（P〉0.05）;术后1a观察组PQRSD[（139.15±7.30）ms]、血浆BNP[（343.95±40.42）ng/L]高于对照组[（134.63±6.70）ms、（202.85±52.03）ng/L],LVEF[（46.60±7.70）%]低于对照组[（49.60±7.00）%],2组比较差异均有统计学意义（P〈0.015）,心功能不全发生率（28%）高于对照组（13%）（P〈0.05）;术前高Hcy水平是术后左心室收缩功能不全的独立危险因素（OR=5.180,95%CI：1.977~17.087,P=0.001）。结论 术前高血浆同型半胱氨酸可影响心脏起搏器右心室心尖部起搏患者左心室收缩功能,该指标可作为右心室起搏术后心脏结构与心功能变化评估指标。Objective To discuss the influence of preoperative high homocysteine on left ventricular systolic function in patients receiving right ventricular apical pacing. Methods A hundred patients with Ⅲ degree atrioventricular block induced by sick sinus syndrome received automatic permanent double-cavity pacemaker DDD or synchronous type singlecavity pacemaker VVI and were detected homocysteine （Hcy） level before operation. All patients were divided into observation group （Hey≥10 μmol/L, n=60） and control group （Hcy〈10 μmol/L, n=40）. The left ventricular ejection fraction （LVEF）, pacemaker rhythm electrocardiogram QRS duration （PQRSD） and brain natriuretic peptide （BNP） level were measured 7 days and one year after operation and were compared between two groups. And the incidence of cardiac insufficiency one year after operation was compared between two groups. Results There were no significant differences in PQRSD and BNP immediately after operation and LVEF 7 days after operation between observation group （（131.52±6.24） ms, （107.15±25.10） ng/L, （49.60±7.30）%） and control group （（133.40±7.66） ms, （73.88± 12.09） ng/L, （51. 80 ±7. 90）%） （P〉0.05）. The levels of PQRSD and BNP were higher in observation group （（139.15±7.30） ms, （343.95±40.42） ng/L） than those in control group （（134. 63±6. 70） ms, （202. 85±52.03） ng/L）, and LVEF was lower in observation group （（46.60 ±7.70）%） than that in control group （（49.60± 7.00）%） （P〈0.05）, and the incidence of cardiac insufficiency was higher in observation group （28%） than that in control group （13%） one year after operation （P〈0.05）. The preoperative high level of plasma Hcy was the independent risk factor for left ventricular systolic dys{unction （OR= 5. 180,95% CI：1. 977 to 17. 087, P=0. 001）. Conclusion The preoperative high level of plasma Hcy can influence left ventricular systolic function in patients with right ventricular apical

关 键 词：病态窦房结综合征 Ⅲ度房室传导阻滞 高同型半胱氨酸 右心室心尖部起搏 左心室收缩功能状态 

分 类 号：R541.7[医药卫生—心血管疾病]