双腔心脏起搏器植入患者心肺耐力及其影响因素的研究  

Cardiorespiratory fitness and its influencing factors in patients with dual-chamber pacemaker implantation

作　　者：张丽[1] 李艳莹[1] 孙丽杰[1] 任川[1] 赵威[1] 刘萍[1] 宋燕新 ZHANG Li;LI Yanying;SUN Lijie(Department of Cardiology,Peking University Third Hospital,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Ministry of Health,Beijing,100191)

机构地区：[1]北京大学第三医院心内科,国家卫健委心血管分子生物学与调节肽重点实验室,北京市100191

出　　处：《中国康复医学杂志》2021年第1期46-50,56,共6页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:探究双腔心脏起搏器植入患者的心肺耐力特点,分析可能影响其心肺耐力的因素,指导双腔心脏起搏器植入患者的心脏康复治疗。方法:回顾性分析了67例双腔心脏起搏器植入患者(起搏器植入组)与匹配的128例一般人群(非起搏器植入组),比较两组临床资料、生化指标、超声心动图参数以及心肺运动测试结果,探究双腔心脏起搏器植入患者的心肺耐力特点。对起搏器植入患者进行亚组分析,通过二元Logistic回归模型进行多因素分析,探寻影响双腔心脏起搏器植入患者心肺耐力的因素。结果:起搏器植入组无氧阈心率、峰值心率、峰值心率占预计值百分比明显低于非起搏器植入组(94.16±18.14 vs105.48±16.36bpm,P<0.001;115.07±22.14 vs 130.14±20.93bpm,P<0.001;75.67±13.64%vs 85.18±11.24%,P<0.001),起搏器植入组峰值摄氧量低于非起搏器植入组(16.8±4.14 vs 18.65±3.90ml/kg/min,P<0.05),两组摄氧效率斜率、二氧化碳通气当量斜率均值无显著性差异(P均>0.05)。起搏器植入组进行亚组单因素分析发现年龄、运动习惯、心室起搏比例、植入年限在两组之间具有显著性差异,多因素分析发现心室起搏比例≥40%是起搏器植入患者心肺耐力下降的独立危险因素(P<0.05,OR=0.167)。结论:双腔心脏起搏器植入患者心肺耐力下降,年龄、运动习惯、心室起搏比例、植入年限是影响其心肺耐力的重要因素,其中心室起搏比例≥40%是影响心肺耐力的独立危险因素。Objective:To explore the cardiorespiratory fitness and its influencing factors in patients with pacemaker implantation,and to provide reference to medical workers to make rehabilitation programs for pacemaker patients.Method:The clinical data,biochemical indexes,echocardiographic parameters and cardiopulmonary exercise test results of 67 patients with dual chamber pacemaker implantation(Pacemaker group)and 128 matched general population(Non-Pacemaker group)were analyzed retrospectively.The cardiorespiratory fitness characteristics of patients with dual chamber pacemaker implantation were explored and the Pacemaker group were analyzed in subgroup to analyze factors affecting the cardiorespiratory fitness through the multivariate logistic regression model.Result:The Pacemaker group shows lower aerobic heart rate,peak heart rate(HRpeak)and HRpeak/pre%(94.16±18.14 vs 105.48±16.36 bpm,P<0.001;115.07±22.14 vs 130.14±20.93 bpm,P<0.001;75.67±13.64%vs 85.18±11.24%,P<0.001)than Non-Pacemaker group.Peak oxygen uptake shows statistical difference during two groups(16.88±4.14 vs 18.65±3.90 ml/kg/min,P<0.05).There was no significant difference in OUES and VE/VCO2 Slope(P>0.05).According to subgroup analysis in Pacemaker group:single factor analysis showed that age,exercise habit and VP proportion years of implantation were statistically different between two subgroups.Multi factor analysis showed that VP proportion≥40%was an independent risk factor for the decline of cardiorespiratory fitness(P<0.05,OR=0.167).Conclusion:The cardiorespiratory fitness of patients with dual chamber pacemaker implantation decreased significantly.Age,exercise habit,the proportion of ventricular pacing and the years of implantation are the important factors that affect the cardiorespiratory fitness,among which the VP proportion≥40%was an independent risk factor for decreased cardiorespiratory fitness.

关 键 词：双腔心脏起搏器 心肺耐力 影响因素 心室起搏比例 

分 类 号：R541[医药卫生—心血管疾病] R49[医药卫生—内科学]