右室不同部位起搏对术后新发房颤和心功能不全影响的研究  

The Effect of Pacing in Different Parts of the Right Ventricle on Postoperative Atrial Fibrillation and Cardiac Insufficiency

作　　者：刘怡[1] LIU Yi(Heart Clinic,Xuzhou Central Hospital,Xuzhou,Jiangsu Province,221009 China)

机构地区：[1]徐州市中心医院心脏诊疗中心,江苏徐州221009

出　　处：《中外医疗》2020年第36期32-34,47,共4页China & Foreign Medical Treatment

摘　　要：目的研究DDD模式下右室不同部位起搏对术后新发房颤和心功能不全的关系。方法随机选取2017年1月—2018年12月期间该院因房室传导阻滞行双腔起搏器植入的患者60例,随机分为两组:右室流出道起搏组(ROVT组)30例和右室心尖部起搏组(RVA组)30例,入组后分别行右室流出道起搏和右室心尖部起搏,术后随访12个月。随访时间为术后1个月、6个月、12个月,在术前及随访时间点完善相关检查:常规十二导联心电图、动态心电图、超声心动图评估以及起搏器程控检查。记录新发房颤发生率及术后第一次发生时间、心功能分级、左心室舒张末期容积(LVEDV)、左室射血分数(LVEF),以评价DDD模式下右室两种不同部位起搏对术后新发房颤以及心功能不全的影响。结果①两组术后房颤发生率[4(13.33%)vs 5(16.67%)]比较差异无统计学意义(χ^(2)=0.000,P>0.05)。ROVT组较RVA组术后房颤第一次发生时间晚于RVA组[(9.12±2.55)月vs(6.34±2.78)月],差异有统计学意义(t=4.036,P<0.05)。②两组术前LVEDV[(46.2±7.1)mm vs(47.3±10.1)mm]及LVEF[(54.1±0.8)%vs(53.8±0.7)%],差异无统计学意义(t=0.488、1.175,P>0.05)。而在术后12个月,ROVT组LVEF高于RVA组[(52.5±0.7)%vs(47.5±0.9)%],LVEDV低于右室心尖起搏组[(47.5±6.9)mm vs(51.2±13.5)mm],差异有统计学意义(t=24.020、4.050,P<0.05)。结论DDD模式下右室ROVT部位起搏较RVC起搏可以减少术后新发房颤和心功能不全的发生,改善预后,提高生活质量。Objective To study the relationship between pacing at different parts of the right ventricle in DDD mode and postoperative atrial fibrillation and cardiac insufficiency.Methods Sixty patients who underwent dual-chamber pacemaker implantation due to atrioventricular block in the hospital from January 2017 to December 2018 were randomly selected and randomly divided into two groups:right ventricular outflow tract pacing group(ROVT group)30 patients;the right ventricular apical pacing group(RVA group)30 cases.Right ventricular outflow tract pacing and right ventricular apical pacing were performed after enrollment.The follow-up was 12 months.Follow-up time was 1 month,6 months,12 months after surgery,and perfect related examinations before operation and follow-up time points:conventional 12-lead electrocardiogram,dynamic electrocardiogram,echocardiogram evaluation and pacemaker program-controlled examination.Record the incidence of new-onset atrial fibrillation and the time of first occurrence after surgery,cardiac function classification,left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),to evaluate two different parts of the right ventricle in DDD mode of the influence of pulsation on new postoperative atrial fibrillation and cardiac insufficiency.Results 1.There was no statistically significant difference in the incidence of postoperative atrial fibrillation between the two groups[4(13.33%)vs 5(16.67%)](χ^(2)=0.000,P>0.05).Compared with the RVA group,the first occurrence of atrial fibrillation in the ROVT group was later than that in the RVA group[(9.12±2.55)months vs(6.34±2.78)months],the difference was statistically significant(t=4.036,P<0.05).2.There was no statistically significant difference in LVEDV[(46.2±7.1)mm vs(47.3±10.1)mm]and LVEF[(54.1±0.8)%vs(53.8±0.7)%]before operation between the two groups,respectively(t=0.488,1.175,P>0.05).At 12 months after surgery,the LVEF in the ROVT group[(52.5±0.7)%vs(47.5±0.9)%]was higher than that in the RVA group,and LVEDV[(47.

关 键 词：右室流出道 起搏右室 心尖部起搏 新发房颤 心功能不全 

分 类 号：R5[医药卫生—内科学]