不同心脏起搏方式对心力衰竭伴心房颤动患者心衰指标、心功能的影响及经济效益分析  

Effect of Different Cardiac Pacing Modes on the Heart failure Indexes and Cardiac Function and Analysis of Economic Benefit in Patients with Heart Failure Complicated with Atrial Fibrillation

作　　者：倪水清 贺集贤[1] 王建平[1] 徐磊[1] 徐鸿[2] Ni Shuiqing;He Jixian;Wang Jianping;Xu Lei;Xu Hong(Second Department of Cardiology, Guangyuan Central Hospital, Guangyuan 628000, China;Department of Respiratory Medicine, Guangyuan Central Hospital, Guangyuan 628000, China)

机构地区：[1]广元市中心医院心内二科,广元628000 [2]广元市中心医院呼吸科,广元628000

出　　处：《成都医学院学报》2020年第2期251-255,共5页Journal of Chengdu Medical College

基　　金：广元市科学技术和知识产权局课题(No:15ZRKX005)。

摘　　要：目的探究不同心脏起搏方式对心力衰竭伴心房颤动患者心衰指标、心功能及经济效应的影响。方法回顾性分析2010年6月至2018年6月,于广元市中心医院行心脏起搏器植入手术的240例心力衰竭伴心房颤动患者的临床资料,根据起搏器植入位置将其分RVA组(右心室心尖部起搏,n=141)与RVS组(右心室间隔部起搏,n=99),观察两组治疗效果。结果RVS组术后1、3个月起搏阈值与电极阻抗均显著低于RVA组,感知阈值高于RVA组(P<0.05);RVS组术后1、3个月左心室不同步指数(Ts-SD)、肺动脉射血前间期-主动脉射血间期(PPEI-APEI)绝对值及QRS时限水平均显著低于RVS组(P<0.05);RVS组术后术后1、3个月心室起博百分比显著低于RVA组;心室感知百分比显著高于RVA组(P<0.05);RVS组术后1、3个月左心室舒张末期容积(LVEDV)、Tei指数均显著低于RVA组;左室射血分数(LVEF)显著高于RVA组(P<0.05);RVS组术后1、3个月血清脑钠肽(BNP)、C反应蛋白(CRP)水平均显著低于RVA组(P<0.05);两组治疗费用比较,差异无统计学意义(P>0.05)。结论RVS起搏能有效改善RVA起搏心室收缩不同步情况,保护心功能,延缓心衰,是一种更为理想的起搏方式。Objective To study the effect of different cardiac pacing modes on the heart failure indexes and cardiac function and analyze the economic benefit in patients with heart failure complicated with atrial fibrillation.Methods The clinical data of 240 patients with heart failure complicated with atrial fibrillation who underwent the cardiac pacemaker implantation in Guangyuan Central Hospital from June of 2010 to June of 2018 were analyzed retrospectively.The patients with the pace-making at the right ventricular apex(RVA)were divided into the RVA group(n=141)and those with the pace-making at the right ventricular septum(RVS)were divided into the RVS group(n=99)according to the pacemaker implantation sites.The treatment effect was observed in both groups.Results The pacing threshold and electrode impedance in the RVS group were significantly lower than those in the RVA group at 1 month and 3 months after operation,and the threshold of perception current in the RVS group was significantly higher than that in the RVA group(P<0.05).The absolute values of Ts-SD and PPEI-APEI and the QRS duration at 1 month and 3 months after operation in the RVS group were significantly lower than those in the RVA group(P<0.05).The percentages of ventricular pulsation at 1 month and 3 months after operation in the RVS group were significantly lower than those in the RVA group,and the percentages of ventricular perception in the RVS group were significantly higher than those in the RVA group(P<0.05).The left ventricular end-diastolic volume(LVEDV)and the Tei index at 1 month and 3 months after operation in the RVS group were significantly lower than those in the RVA group,and the left ventricular ejection fraction(LVEF)in the RVS group was significantly higher than that in the RVA group(P<0.05).The levels of serum brain natriuretic peptide(BNP)and C-reactive protein(CRP)at 1 month and 3 months after operation in the RVS group were significantly lower than those in the RVA group(P<0.05).There was no significant difference in the treatment

关 键 词：不同心脏起搏方式 心力衰竭伴心房颤动 心衰指标 心功能 经济效益 

分 类 号：R541.7[医药卫生—心血管疾病]