右室不同部位起搏对患者心功能及心理状态的影响  

The effect of right ventricular pacing at different sites on cardiac function and psychological state of patients

作　　者：朱琳[1] 侯爱军[1] 刘刚[2] 郑明奇[2] 李鹤飞[1] 武艳强[1] 陈巍巍[1] 王育梅[2] 

机构地区：[1]邯郸市中心医院心内四科,河北省邯郸市056002 [2]河北医科大学第一医院心内一科

出　　处：《中国心血管病研究》2017年第10期908-912,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的分析右室流出道（RVOT）间隔部起搏及右室心尖部（RVA）起搏对患者心功能及心理状态的影响。方法选取2014年3月至2016年3月邯郸市中心医院接受心脏起搏器治疗的189例患者，随机分为2组：RVOT间隔部起搏组（简称RVOT组）93例和RVA起搏组（简称RVA组）96例。分别于术前、术后1周采集两组患者心电图QRs波群时限、QT间期，于术前、术后1年行心脏超声检查，采集左室舒张末内径（LVEDD）、左室射血分数（LVEF）、左房内径（LAD）参数；于术前、术后1周、术后3个月及术后1年对两组患者使用汉密尔顿焦虑评分量表（HARS）和汉密尔顿抑郁量表（HDRS）进行心理评估。结果RVA组及RVOT组术后QRS波群时限较术前延长[（153．23±15．17）ms比（116．35±14．27）ms，（133．16±11．34）ms比（117．42±15．82）ms]（P〈0．01），QT间期较术前延长[（424．06±30．31）ms比（396．24±45．06）ms．（413．26±33．75）ms比（395．16±44．44）ms]（P〈0．01），且RVA组QRS波群时限、QT间期较RVOT组显著延长（P〈0．01）。RVA组术前LVEDD、LVEF、LAD与术后1年相比有显著差异[（30．96±4．98）mm比（31．06±5．17）mm，（48．88±5．78）mm比（49．03±5．86）mm，（48．97±6．97）％比（47．83±7．09）％]（P〈0．01）；RVOT组术前LVEDD、LVEF、LAD与术后1年相比未见统计学差异（P〉0．05）。RVA组术前及术后1周HARS及HDRS比较未见统计学差异（P〉0．05），术后3个月及1年相比差异有统计学意义（P〈0．05）；RVOT组术前及术后1周、术后3个月、术后1年HARS及HDRS比较均未见统计学差异。结论RVOT较RVA对患者心功能及心理状态影响更小，为临床更适宜选择的起搏器植入部位。Objective To compare the effects of different pacing sites on cardiac function and psychology, including right ventricular outflow tract septum （RVOT） pacing and right ventricular apex （RVA） pacing. Methods 189 patients with cardiac pacemaker treatment treated in our hospital from March 2014 to March 2016 were selected and randomly divided into two groups： 93 cases in RVOT pacing group, 96 cases in RVA pacing group. Electrocardiogram parameters were compared between the two groups before operation and after 1 week, including QRS duration, QT interval. Ultrasound parameters were compared between the two groups before operation and after 1 year, including the left ventricular diastolic （LVEDD）, left ventricular ejection fraction （LVEF）, left atrial diameter（LAD）. Hamilton Anxiety Rating Scale（HARS） and Hamilton Depression Rating Scale（HDRS） were used to evaluate psychological assessment of patients during 4 times： before operation, after lweek, after 3 months, after 1 year. Results The QRS duration in RVA group and RVOT group were longer than those before operation [ （153.23±15.17）ms vs （116.35±14.27）ms, （133.16±11.34）ms vs （117.42±15.82）ms]（P〈0.01）, QT interval were also longer [（424.06±30.31 ）ms vs （396.24±45.06）ms, （413.26±33.75）ms vs （395.16±44.44）ms]（P〈0.01）, and the QRS duration and QT interval in RVA group were significantly longer than those in RVOT group （P〈0.01）. There were significant differences in LVEDD, LVEF and LAD in RVA group after 1 year [ （30.96±4.98）mm vs （31.06±5.17）mm, （48.88±5.78）mm vs （49.03±5.86）mm, （48.97±6.97）% vs （47.83±7.09） mini（P〈0.01 ）, but no significant difference in RVOT group（P〉0.05 ）. There was no significant difference between the HARS and the HDRS in the RVA group （P〉0.05）, and there was significant difference between the three months and the first year（P〈0.05）, and 1 week after surgery, 3 months after surgery, 1 year. Conclusion Compa

关 键 词：起搏部位 心功能 焦虑 抑郁 

分 类 号：R541.7[医药卫生—心血管疾病]