摘要【目的】比较右室间隔部(RVS)与右室心尖部(RVA)起搏器植入治疗房室传导阻滞患者的临床效果。【方法】回顾性分析2015年6月至2017年1月本院收治的84例房室传导阻滞患者的临床资料,根据起搏器植入部位的不同将其分为观察组(RVS植入,n=42)和对照组(RVA植入,n=42)。比较两组的QRS波群时限、左室射血分数(LVEF)、左房泵血分数(LAEF)、氨基末端B型脑钠肽前体(NT-proBNP)水平和不良反应发生情况。【结果】治疗后,观察组QRS波群时限水平低于对照组[(0.13±0.02)s vs (0.17±0.04)s],差异具有统计学意义(P<0.05);观察组LVEF、LAEF水平均高于对照组[(50.21±3.60)% vs (47.00±1.58)%,( 53.04±3.02)% vs (48.51±2.44)%],差异具有统计学意义(P<0.05);观察组血浆NT-proBNP水平低于对照组,差异具有统计学意义(P<0.05);观察组不良反应总发生率低于对照组[7(16.67%) vs 18 (42.86%)],差异具有统计学意义(χ2=6.1247,P=0.0133<0.05)。【结论】RVS起搏植入治疗房室传导阻滞较RVA效果更佳,更有利于左室射血功能和左房泵血功能的恢复,且不良反应发生率低,值得应用推广。
[1] 徐亮,陈燕春,蒋超旦, 等. 不同起搏方式对患者左心结构与功能及NT-proBNP的影响[J].医学临床研究,2014.31(6):1101-1103.
[2] Nijenhuis VJ, Van Dijk VF, Chaldoupi SM,et al.Severe conduction defects requiring permanent pacemaker implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation[J].Europace,2017,19(6):1015-1021.
[3] 包忠武,申强,蒋军军, 等. 右心室不同部位起搏对心脏结构和左心功能的影响[J].医学临床研究,2011,28(3):401-404.
[4] Hoffmann DA, Atama uk AN, Ruiz GA, et al.Symptomatic, Inspiration-Induced Atrioventricular Block: Treated with Pacemaker Implant[J].Pacing Clin Electrophysiol,2017,40(7):900-903.
[5] 邹媛,岳文胜,王亚萍,等. 不同起搏模式对左心室功能及左心室短轴应变的影响[J].中国医学影像技术,2014,30(08):1188-1193.
[6] Wang RX, Lee HC, Li JP, et al.Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation[J].Clin Cardiol,2017,40(1):18-25.
[7] 刘瑾. 右心室起搏部位对左心室收缩同步性的影响[J].江苏医药,2014,40(19):2265-2267.
[8] Zhang H, Pan C, Zhang J,et al.Olmesartan Reduces New-onset Atrial Fibrillation and Atrial Fibrillation Burden after Dual-chamber Pacemaker Implantation in Atrioventricular Block Patients[J].Chin Med J (Engl),2016,129(18):2143-2148.
[9] 杨玲,杨晓宇,柯海燕, 等. Ⅲ度房室传导阻滞患者双腔起搏器植入术后血浆NT-proBNP水平的变化[J].江苏医药,2014,40(21):2541-2544.
[10] Liao JN, Chao TF, Tuan TC, et al.Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing[J].Medicine (Baltimore),2016,95(35):e4668.
[11] 李文华,李勇,季建国, 等. 右室不同部位起搏对血浆IL-6、ANP水平和左心功能的影响[J].南京医科大学学报(自然科学版),2012,32(09):1254-1258.
[12] Toledano B, Bisbal F, Camara ML,et al.Incidence and predictors of new-onset atrioventricular block requiring pacemaker implantation after sutureless aortic valve replacement[J].Interact Cardiovasc Thorac Surg,2016,23(6):861-868.
[13] 赵清珍,刘刚,刘超, 等. 不同起搏器植入部位对房室传导阻滞患者情绪状态的影响[J].中国全科医学,2017,20(18):2197-2200.
[14] de Oliveira GB, de Oliveira FS, Osório AP,et al.Late Outcome and Predictors of Adverse Events Related to the Implantation of a Permanent Pacemaker in Patients with Isolated Congenital Atrioventricular Block[J].Pediatr Cardiol,2016,37(7):1319-1327.
[15] 俞杉,吴强,卜婕, 等. 组织多普勒评价右室不同部位起搏对左室机械运动同步性的影响[J].中国超声医学杂志,2014,30(6):516-519.
[16] Fujioka T, Nii M, Tanaka Y.A premature low-birth-weight infant with congenital complete atrioventricular block and myocarditis successfully treated by staged pacemaker implantation[J].Cardiol Young,2016,26(5):1029-1032.
[17] 杨芳,岳文胜,黄多, 等. 不同起搏模式对右心室功能影响的随机交叉对照研究[J].中国超声医学杂志,2013,29(10):906-909.
[18] Ozturk C, Unlu M, Yildirim AO,et al.The progressed atrioventricular block associated with ticagrelor therapy may not require permanent pacemaker after acute coronary syndrome; it may be reversible[J].Int J Cardiol,2016,15(203):822-824.