希浦系统起搏对老年起搏诱导性心肌病病人效果的Meta分析  

A Meta-analysis on the efficacy of His-Purkinje system pacing in elderly patients with pacing-induced cardiomyopathy

作　　者：成荣 周昊阳 李颖[1] 张成 李春雨 陈彦 CHENG Rong;ZHOU Haoyang;LI Ying;ZHANG Cheng;LI Chunyu;CHEN Yan(Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215000,China;Central Laboratory,Longjiang Branch of the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Intensive Care Unit,Longjiang Branch of the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学姑苏学院,江苏省苏州市215000 [2]南京医科大学第一附属医院龙江院区中心实验室,江苏省南京市210029 [3]南京医科大学第一附属医院龙江院区重症医学科,江苏省南京市210029

出　　处：《实用老年医学》2024年第6期557-563,共7页Practical Geriatrics

基　　金：江苏省医学重点人才(ZDRCA2016016);2023年江苏省研究生科研与实践创新计划(SJCX23_0710);江苏省医院协会医院管理创新研究重点课题(JSYGY-3-2023-384);健康江苏研究院2022年度决策咨询培育课题(JX102C20160020);2021年研究生优质教育资源建设项目(2021B016)。

摘　　要：目的评估右心室起搏后,患起搏诱导性心肌病的老年病人升级至希浦系统起搏的临床疗效和安全性。方法在PubMed、Cochrane Library、Web of Science、Embase、中国知网、万方数据库、维普数据库检索希浦系统起搏对起搏诱导性心肌病疗效的相关文献,提取研究中有关临床获益和安全性的数据,在RevMan 5.4软件上进行Meta分析。结果共纳入8篇文献,包括185例病人,升级希浦系统起搏的成功率为95%。Meta分析结果显示:升级希浦系统起搏后,随访期间病人的左心室射血分数(MD=-11.73,95%CI:-14.74~-8.72,P<0.01)较升级术前提高,QRS波时限(MD=59.84,95%CI:55.98~63.70,P<0.01)较升级术前缩短,NYHA心功能分级(MD=1.05,95%CI:0.70~1.41,P<0.01)较升级术前明显降低,差异均有统计学意义。起搏阈值(MD=-0.11,95%CI:-0.24~0.02,P=0.08)和R波振幅(MD=-0.35,95%CI:-1.94~1.24,P=0.66)升级术前后差异无统计学意义。同时研究中观察到2例病人死亡。结论对于老年起搏诱导性心肌病病人,可考虑升级起搏方式为希浦系统起搏,不仅可以纠正长期右心室起搏引起的心脏电不同步和心室重塑,同时也能改善病人的临床心功能并减少手术相关并发症。Objective To evaluate the efficacy and clinical benefit of upgrading to His-Purkinje system conduction system pacing(HPCSP)in the elderly patients with pacing-induced cardiomyopathy(PICM)after right ventricular pacing(RVP).Methods The literatures on Hirsch-Purkinje system(Hirsch-Purkinje system)pacing in the patients with PICM were searched from PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang Data and VIP Database,based on inclusion and exclusion criteria.The relevant data on clinical efficacy and safety were extracted from the studies,and were analyzed by RevMan 5.4 software.Results A total of 8 literatures were enrolled in this study,and 185 patients were included.The successful rate of HPCSP was 95%.The results of Meta-analysis showed that,compared with baseline,patients’left ventricular ejection fraction(MD=-11.73,95%CI:-14.74--8.72,P<0.01)was significantly increased,QRS duration(MD=59.84,95%CI:55.98-63.70,P<0.01)was shortened,cardiac function classification of New York Heart Association(MD=1.05,95%CI:0.70-1.41,P<0.01)was significantly increased.No significant differences were observed in pacing threshold(MD=-0.11,95%CI:-0.24-0.02,P=0.08)and R-wave(MD=-0.35,95%CI:-1.94-1.24,P=0.66)before and after the upgrading operation.Conclusions For the elderly patients with PICM,upgrading the pacing mode to HPCSP should be considered.HPCSP can correct electrical dissynchronization and ventricular remodeling caused by long-term right ventricular pacing,and can improve clinical cardiac function and reduce surgery-related complications.

关 键 词：希浦系统起搏 希氏束起搏 左束支起搏 起搏诱导性心肌病 老年人 右心室起搏 META分析 

分 类 号：R541.6[医药卫生—心血管疾病]