心脏起搏器植入术后三尖瓣反流影响因素分析  

The effects of right ventricular pacing on tricuspid regurgitation

作　　者：李国草[1] 李莹[1] 高连君[1] 夏云龙[1] 尹晓盟[1] 常栋[1] 于晓红[1] 从涛[1] 王莹琦[1] 董颖雪[1] Li Guocao;Li Ying;Gao Lianjun;Xia Yunlong;Yin Xiaomeng;Changdong;Yu Xiaohong;Cong Tao;Wang Yingqi;Dong Yingxue.(Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China)

机构地区：[1]大连医科大学附属第一医院心内科,116011

出　　处：《中华心律失常学杂志》2018年第3期222-228,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81200137）

摘　　要：目的研究心脏起搏器植入后三尖瓣反流（TR）程度的发生率及进展情况，并分析其可能的影响因素。方法连续选取2010年1月至2012年12月在大连医科大学附属第一医院心内科行单／双腔永久心脏起搏器的超声心动图资料完整患者147例行回顾性分析。观察患者手术前后TR程度的变化，并行多因素Logistic回归分析。结果与对照组比较，新发反流组术前右心室内径更大[（21．50±4．60）mm对（19．45±3．40）mm，P=0．018]。多因素分析发现术前TR程度越轻，术后TR进展比例越高（OR=0．07，95％CI0．01-4）．64，P=0．018），术前右心室内径越大，术后TR进展比例越高（OR=1．167，95％CI1．01～1．35，P=0．040）。结论术前TR程度可作为右心室电极导线植入后TR进展的一个预测因素；术前右心室大小与TR进展及新发均相关，术前右心室越大，术后TR进展及新发比例越高。Objective To study the incidence of tricuspid regurgitation （ TR ） after right ventricular （ RV ） leads implantation, and to analysis the possible influence factors and mechanism. Methods A total of 147 patients were consecutively selected between January 2010 to December 2012 in First Affiliated Hospital of Dalian Medical University, with an enrolling of complete clinic and ultrasound data. Patients underwent a permanent pacemakers （ PPM ）, implantable cardioverter defibrillator （ ICD ） or cardiac resynchronization therapy pacemake （ CRT-P ） implantation or replacement in cardiology of Dalian Medical University first affiliated hospital. Clinical date and echocardiography date were collected for a retrospective analysis. Multi-factor logistic regression analysis was made if multiple factors included. Results Aggravated group had a larger RV diameter and left ventricular diameter, and a higher proportion of no or mild TR preoperative compared with the control group. Multi-factor anlalysis for aggravated group showed that the less TR preoperative （ OR=0.07,95% CI0.01-0.64, P=0.018 ）, the bigger RV diameter （ OR=1.167,95%CI 1.01-1.35, P=0. 04 ）, the bigger left ventricular diameter（ OR=1.079,95%CI 1.01-1.15, P=0.027 ）, the more TR aggravating postoperative. Compared with the control group, new reflur group have lager RV diameter [ （ 21.50 ± 4.60 ） mm vs. （ 19.45 ±3.40 ） ram, P=0.018 ]. Conclusion Preoperative TR degree might be a predictor of TR aggravating after implantation of RV leads. The preoperative RV size related to TR aggravating and new reflux, larger RV size, higher proportion of TR aggravating or new reflux.

关 键 词：心脏起搏器 人工 三尖瓣闭锁不全 

分 类 号：R654.2[医药卫生—外科学]