主动电极右室间隔不同起搏部位对心功能的影响  

Effect of different implantation sites of active fixation electrode on cardiac function in right ventricular septal pacing

作　　者：田由鹏 邵江 牟华明 马士容 石伟 吴中杰 黄亮 吴强 汪建兵 牟桂琴 TIAN You-Peng;SHAO Jiang;MOU Hua-Ming;MA Shi-Rong;SHI Wei;WU Zhong-Jie;HUANG Liang;WU Qiang;WANG Jian-Bing;MOU Gui-Qin(Department of Cardiology,Chongqing University Three Gorges Hospital,Chongqing 404000,China;Department of Ultrasonography,Chongqing University Three Gorges Hospital,Chongqing 404000,China)

机构地区：[1]重庆大学附属三峡医院心血管内科,重庆404000 [2]重庆大学附属三峡医院超声科,重庆404000

出　　处：《中华老年多器官疾病杂志》2021年第8期572-576,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：重庆市卫生健康委员会2014年医学科研计划项目(20142137)。

摘　　要：目的比较主动电极在右室间隔(RVS)不同位置起搏的QRS波宽度、血清氨基末端B型利钠肽前体(NT-proBNP)及血流动力学指标,探索右室间隔最佳起搏部位。方法选择2014年7月至2018年2月重庆大学附属三峡医院心血管内科收治的符合人工永久起搏器植入适应证、行单腔起搏器植入的177例患者为研究对象,根据在X线前后位透视下心室主动电极植入部位与脊椎影高度对比,将患者分为右室高、中、低位间隔组,其中高位间隔组54例,中位间隔组68例,低位间隔组55例。记录术前及术后QRS波群宽度、血清NT-proBNP及血流动力学指标,同时在起搏器植入术前、术后6个月及术后1年测量左室舒张末期前后径(LVEDD)、左心射血分数(LVEF)、每搏输出量(SV)及左室短轴缩短率(LVFS)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,组间比较分别采用方差分析、非参数检验、χ^(2)检验及Fisher精确概率检验。结果各组术前QRS、血清NT-proBNP、LVEDD、LVEF、LVFS及SV比较,差异均无统计学意义(P>0.05)。术后各组QRS均较术前增宽,组间比较中位组术后QRS波最窄,低位组最宽(P<0.05)。中位组术后NT-proBNP较术前明显降低(P<0.05),高位组及低位组术后6个月及1年均较术前明显升高(P<0.05)。高位组及低位组术后6个月及1年LVEDD均大于中位组(P<0.05);中位组术后LVEDD小于术前,低位组术后LVEDD大于术前(P<0.05)。中位组术前与术后LVEF、LVFS、SV无明显变化(P>0.05);中位组术后6个月SV及术后1年LVEF、LVFS、SV较低位组明显升高,与高位组相比则仅有术后1年LVEF有显著升高(P<0.05)。结论右室中位间隔部位对心功能影响较小,是最合适的右室间隔起搏位置。Objective To investigate the best pacing sites of right ventricular septum(RVS)by comparing QRS wave width,serum N-terminal pro B-type natriuretic peptide(NT-proBNP)level and hemodynamic indicators in the patients undergoing different electrode positions in RVS.Methods A total of 177 patients who met the indications for artificial permanent pacemaker implantation and underwent single-chamber pacemaker implantation in our hospital from July 2014 to February 2018 were recruited in this study.According to the implantation site of active fixation electrode compared with height of vertebral shadow under X-ray at the posteroanterior position,they were divided into right ventricular high-septal(n=54),median-septal(n=68),and low-septal groups(n=55).The width of QRS complex,serum NT-proBNP level and hemodynamic indicators were recorded before and after operation.Left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),stroke volume(SV)and left ventricular fractional shor-tening(LVFS)were measured before and 6 months and 1 year after pacemaker implantation.SPSS statistics 26.0 was used for statistical analysis.One-way analysis of variance,non-parametric test,Chi-square test or Fisher exact probability test was adopted for intergroup comparison depending on different data types.Results There was no statistical difference in preoperative QRS width,serum NT-proBNP level,LVEDD,LVEF,LVFS and SV in the three groups(P>0.05).After operation,QRS width was increased in all groups,and it was the narrowest in the median-septal group,and widest in the low-septal group(P<0.05).Post-operative NT-proBNP was significantly lower in the median-septal groups than before(P<0.05),and both the low-septal group and high-septal group increased significantly at 6 months and 1 year after operation(P<0.05).The LVEDD of high-septal group and low-septal group was greater than that of median-septal group at 6 months and 1 year after operation(P<0.05);LVEDD of median-sptal group was less than that before operation;LVEDD of

关 键 词：心脏起搏器 人工 主动电极 室间隔 起搏部位 心功能 

分 类 号：R541.7[医药卫生—心血管疾病]