心脏永久性起搏器的不同起搏部位对植入患者心功能的影响  

Effect of different pacing sites of permanent pacemaker on cardiac function of implanted patients

作　　者：王亚玲[1] 张杨[1] 郭安君 饶明月[1] 张晓丹 孟建康 WANG Ya-ling;ZHANG Yang;GUO An-jun;RAO Ming-yue;ZHANG Xiao-dan;MENG Jian-kang(The First Department of Cardiovascular Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050035, China)

机构地区：[1]河北医科大学第二医院东院心内一科,河北石家庄050035

出　　处：《河北医科大学学报》2022年第1期22-25,30,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划(20190589)。

摘　　要：目的探讨心脏永久性起搏器的不同起搏部位对植入患者心功能的影响。方法我院心血管内科接受心脏永久性起搏器植入术的患者80例,根据患者起搏部位将其分为A组(30例,于右心室心尖部植入心脏永久性起搏器)、B组(50例,于右心室间隔植入心脏永久性起搏器),对两组的临床资料进行回顾性研究分析,比较两组的N末端脑钠肽水平(N-terminal pro-brain natriuretic peptide,NT-proBNP)、心脏彩色超声监测指标[包括左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)和左心室射血分数(left ventricular ejection fraction,LVEF)]、生命质量评分、心脏不良事件发生率。结果两组植入后的NT-proBNP水平均较植入前显著降低,差异有统计学意义(P<0.05),而植入后NT-proBNP水平在B组中均低于A组,差异有统计学意义(P<0.05);两组植入后的LVEF、LVEDD、LVESD均较植入前显著改善(P<0.05),而植入后B组的LVEF较A组更高(P<0.05),B组的LVEDD、LVESD均较A组更低,差异有统计学意义(P<0.05);两组生命质量评分(情绪领域、身体领域、其他领域和综合得分)在植入后均较植入前显著降低(P<0.05),而植入后的生命质量评分(情绪领域、身体领域、其他领域和综合得分)在B组中低于A组,差异有统计学意义(P<0.05);植入后6个月随访,A组患者当中有出现心房颤动2例,出现心力衰竭1例,出现心率异常2例,B组患者当中有出现心房颤动3例,出现心力衰竭3例,出现心率异常1例,心脏不良事件发生率在A组、B组中分别为16.67%、14.00%,两组患者的心脏不良事件发生率差异无统计学意义(P>0.05)。结论心脏永久性起搏器起搏部位对患者心功能具有一定的影响,于右心室间隔植入心脏永久性起搏器可更好地改善患者心功能,且不会增加心脏不良事件风险。Objective To explore the effect of different pacing sites of permanent pacemaker on cardiac function of implanted patients.Methods In total,80 patients who received permanent pacemaker implantation in the Department of Cardiology of our hospital were included in the study,and were divided into group A(30 patients with permanent pacemaker implantation at the apex of the right ventricle)and group B(50 patients with permanent pacemaker implantation at the septum of the right ventricle)according to the pacing sites.The clinical data of the two groups were analyzed retrospectively.The levels of N-terminal brain natriuretic peptide(NT-proBNP),cardiac color ultrasound indicators[including left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)],quality of life score,and incidence of adverse cardiac events were compared between two groups.Results The levels of NT-proBNP after implantation in both groups were significantly lower than those before implantation(P<0.05),while the levels of NT-proBNP after implantation in group B were lower than those in group A,suggesting significant differences(P<0.05).The LVEF,LVEDD and LVESD after implantation were significantly improved in both groups(P<0.05),while the LVEF in group B was higher than that in group A(P<0.05),and the LVEDD and LVESD in group B were lower than that in group A,with significant difference(P<0.05).The quality of life scores(emotional field,physical field,other fields and comprehensive scores)of the two groups were significantly lower after implantation than those before implantation(P<0.05),while the quality of life scores(emotional field,physical field,other fields and comprehensive scores)after implantation in group B were lower than those in group A,with statistical significance(P<0.05).At 6-month follow-up,there were 2 cases of atrial fibrillation,1 case of heart failure and 2 cases of abnormal heart rate in group A,and 3 cases of atrial fibrillation,3 cases of heart failure a

关 键 词：心律失常 心力衰竭 心脏起搏器 人工 

分 类 号：R541.7[医药卫生—心血管疾病]