43例植入VVI起搏器患者右室心尖起搏和右室流出道起搏的疗效比较分析  

Comparison of Right Ventricular Outflow Versus Apical Pacing in VVI Pacemaker Patients

作　　者：向睿[1] 赵建全[2] 何泉[1] 

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016 [2]巴彦淖尔市医院,内蒙古临河015000

出　　处：《内蒙古医学杂志》2015年第5期513-517,共5页Inner Mongolia Medical Journal

摘　　要：目的探讨植入VVI起搏器患者,相对于右室心尖部起搏(RVAP),右室流出道起搏(RVOT)是否具有减少并发症的优势性。方法对重庆医科大学附属第一医院2010年至2012年43例植入VVI起搏器患者进行回顾性分析,根据右室电极放置部位分为RVAP起搏组(n=16)和RVOT起搏组(n=17)。在术前、术后3个月、12个月进行随访,内容为临床评估,左室射血分数,QRS波群时限,BNP水平和纽约心功能分级(NYHA)。结果术后平均随访(0.8±0.4)年,两组术后QRS波群时限较术前均有所延长,RAP、RVOT分别延长了(40±29)、(56±25)ms vs(24±22)、(32±25)ms,P<0.05;且RVAP延长的幅度明显大于RVOT(14±28)、(22±26)ms,P<0.05,差异均有统计学意义。两组术后的LVEF较术前均有下降,RAP、RVOT分别为(-3±8)%、(-4±9)%vs(-1±6)%、(-2±7)%,差异有统计学意义。在起搏器综合征发生率、LEVF、NYHA分级、BNP、再住院率和死亡率也差异无统计学意义。结论 RVAP引起QRS时程延长,且LVEF值降幅大于RVOT,但差异无统计学意义。在起搏器综合征发生率、左心功能受损,心方面衰竭发生率方面,RVOT优势性也不明显,可为诊断治疗提供参考。Objective To investigate,right ventricular apex pacing（RVAP）compared with right ventricular outflow tract pacing（RVOT）which have the advantage of reducing complications in the implanted VVI pacemaker patients.Methods We conducted a retrospective study in 43 VVI pacemaker recipients from2010 to 2012in first affiliated hospital of chongqing medical University.The patients were divided into RAP group（n=16）and RVOT group（n=17）according to the position of right ventricular lead.Clinical evaluation,N-terminal pro-brain natriuetic peptide（BNP）levels,left ventricular ejection fraction（LVEF）,QRS duration and New York Heart Association（NYHA）functional class were analysed before and 3、12 mouth after the implantation.Results The average years of follow-up was 0.8±0.4 years.Compared with the baseline,the QRS duration were longer in both groups at 3 and 12 mouth follow-up changed（40±29）,（56±25）ms for RAP and（24±22）,（32±25）ms for RVOT,P〈0.05,which the extent of RAP was significantly longer with RVOT（changed（14±28）、（22±26）ms respectively,P〈0.05.LVEF were reduced on both groups from baseline（-3±8）%,（-4±9）% for RAP vs（-1±6）%,（-2±7）%for RVOT.Similarly,no significant difference was observed on pacemaker syndrome,LVEF,NYHA functional class,BNP,and survival.Conclusions RVAP Extended range of QRS and the LVEF value is greater than the decline in RVOT,but the difference was not statistically significant.RVOT pacing site is not superior to conventional apical pacing on pacemaker syndrome,BNP levels,left LVEF,QRS duration and NYHA functional class,which can provide reference for the diagnosis and treatment.

关 键 词：VVI 右室心尖起搏 右室流出道起搏 

分 类 号：R541.61[医药卫生—心血管疾病]