机械瓣置换术后永久性起搏器植入情况及危险因素分析  

Analysis for the Occurrence Rate of Permanent Pacemaker Implantation With Relevant Risk Factors in Patients After Mechanical Heart Valve Replacement

作　　者：张金萍[1] 江勇[1] 吴伟春[1] 王靖金 张丽[1] 张茗卉[1] 王浩[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京市100037

出　　处：《中国循环杂志》2016年第6期569-572,共4页Chinese Circulation Journal

摘　　要：目的：探讨我国主动脉瓣机械瓣置换术后永久性起搏器植入（PPI）发生率及相关危险因素。方法：纳入1986例主动脉瓣机械瓣置换术患者,其中有61例患者因严重心律失常行PPI,为PPI组,男性27例（45%）,平均年龄（53.6±9.03）岁;1925例患者未行PPI为非PPI组。换瓣术后随访时间为（4.47±4.36）年。结果：换瓣术后PPI总体发生率为3.07%,30天内PPI发生率为0.55%,中期（30天~1年）PPI发生率为0.03%,远期（〉1年）PPI发生率为2.22%。PPI组患者的年龄、房颤患者所占比例高于非PPI组（P〈0.05）。在进行PPI的病因中以高度房室传导阻滞居多,占70.5%（包含心房颤动伴长间歇30例,高度房室传导阻滞12例,完全性左束支阻滞1例）,病态窦房结综合征/窦性停搏/窦性心动过缓占14.8%。结论：我国机械瓣置换术后PPI发生率处于较低水平,远期发生率高于近、中期发生率;高龄和心房颤动可能是PPI的高危因素,换瓣术后起搏器植入的临床适应证主要是高度房室传导阻滞。Objective： To explore the occurrence rate of permanent pacemaker implantation （PPI） with relevant risk factors in patients after mechanical aortic valve replacement. Methods： A total of 1986 consecutive patients with mechanical aortic valve replacement were enrolled in this study. According to PPI conduction caused by severe arrhythmia, the patients were divided into 2 groups： PPI group, n=61 including 27 male with the average age of （53.6 ± 9.03） years and Non-PPI group, n=1925. The median follow-up time was （4.47 ± 4.36） years after valve replacement. Results： The patients in PPI group were with the elder age and higher ratio of pre-existing atrial fibrillation （AF） than those in Non-PPI group, P〈0.05. The overall PPI occurrence rate was 3.07% after valve replacement and the short term incidence rate （within 30 days） was 0.55%, midterrn （from 30 day to 1 year） was 0.03%, long term （〉1 year） was 2.22%. For PPI indications, there were 70.5% patients with high degree A-V block including 30 of AF combining long intervals, 12 of high degree A-V block, 1 of complete left bundle branch block （LBBB） and 14.8% patients with sick sinus syndrome/sinus arrest/ sinus bradycardia. Conclusion： PPI incidence was at a relative low level, the long term occurrence rate was higher than both short term and midterm; elder age, pre-existing AF could be the high risk factors for PPI requirement, and the major PPI indication was high degree AV block in clinical practice.

关 键 词：心脏瓣膜病 心脏瓣膜置换 心脏起搏器 人工 心房颤动 

分 类 号：R54[医药卫生—心血管疾病]