儿童永久起搏器植入术围手术期心肌损伤及心功能改变的研究  

A study on myocardial injury and cardiac function changes during the perioperative period of permanent pacemaker implantation in children

作　　者：周云国 朱荻绮[1] 吉炜 ZHOU Yunguo;ZHU Diqi;JI Wei(Department of Cardiology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Pediatric Heart Disease Treatment Center,Jiangxi Provincial Children's Hospital,The Affiliated Children's Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,上海200127 [2]江西省儿童医院心脏病治疗中心,南昌大学附属儿童医院,江西南昌330006

出　　处：《临床儿科杂志》2021年第10期721-725,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金(No.81470443)。

摘　　要：目的探讨儿童永久起搏器植入术围手术期心肌损伤及心功能改变。方法回顾分析2018年11月至2019年10月收治的因各类心动过缓行永久起搏器植入术患儿的临床资料,比较起搏器植入术前、术后1天、术后1周患儿血肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽原(NT-proBNP),以及术前与术后1周经胸超声心动图检查的左心室舒张末期内径(LVEDD)Z值和左心室射血分数(LVEF)。结果入选21例患儿,男8例、女13例,年龄8.0岁(4.0~11.0岁),体质量26.1kg(15.3~45.8kg)。植入双腔起搏器15例,植入单腔起搏器6例。21例患儿在心脏起搏器植入术前、术后1天和术后1周cTnI和CK-MB水平的差异有统计学意义(P<0.001)。cTnI和CK-MB在术后1天最高,分别高于术前和术后1周,差异有统计学意义(P<0.05)。21例患儿心脏起搏器植入术后1周的LVDD-Z值和LVEF值均低于术前,差异有统计学意义(P<0.05)。结论心动过缓患儿植入永久起搏器后可出现短暂、轻度、可逆的心肌损伤,但对心功能有保护作用。Objective To investigate perioperative myocardial injury and cardiac function changes in children undergoing permanent pacemaker implantation.Methods The clinical data of children who underwent permanent pacemaker implantation for various types of bradycardia from November 2018 to October 2019 were reviewed.The blood troponin I(cTnI),creatine kinase(CK)-MB isoenzyme,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)of the children were compared before the pacemaker implantation operation,1 day after and 1 week after the operation.The left ventricular end diastolic diameter(LVEDD)Z value and left ventricular ejection fraction(LVEF)by transthoracic echocardiography before and 1 week after the operation were compared.Results Twenty-one children(8 boys and 13 girls)were included,with an age of 8.0(4.0-11.0)years and a weight of 26.1(15.3-45.8)kg.Dual-chamber pacemakers were implanted in 15 cases and single-chamber pacing in 6 cases.There were statistically significant differences in the levels of cTnI and CK-MB in 21 children before,1 day after and 1 week after pacemaker implantation(P<0.001).The levels of cTnI and CK-MB were the highest one day after operation,which were higher than those before and one week after operation,respectively,with statistical significance(P<0.05).The LVDD-Z and LVEF values of 21 children one week after pacemaker implantation were lower than those before implantation,and the difference was statistically significant(P<0.05).Conclusions Children with bradycardia may experience shortterm,mild and reversible myocardial damage after implantation of a permanent pacemaker,but it has a protective effect on heart function.

关 键 词：永久起搏器植入术 心肌损伤 心功能 儿童 

分 类 号：R726.5[医药卫生—儿科]