右室不同部位起搏对完全性房室传导阻滞患者心脏结构和功能的影响

发布时间：2018-05-11 04:04

本文选题：心尖部起搏 + 间隔部起搏　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:人工心脏起搏治疗是完全性房室传导阻滞患者的常规治疗手段,而右室心尖(RVA)是传统的心室电极植入部位,但其可能损害心脏结和功能并增加术后房颤发生率。之前有多项对比RVA起搏与非RVA起搏的研究,但是得出了矛盾的结论,本研究意在对比非RVA起搏与RVA起搏对心脏结构、功能的影响,探究右室间隔部(RVS)起搏在左室功能正常的完全性房室传导阻滞患者中能否产生更大的益处。方法:本研究采用回顾性研究的方法。从2010年12月至2011年12月期间入住青大附院心内科的患者中,随机筛选60例主要诊断为完全性房室传阻滞并行永久性心脏双腔起搏器植入者,排除房颤、心衰、窦房结病变史、合并其他心房纤颤危险因素疾病以及恶性肿瘤患者等,将入组患者分为两组:RVA组为心尖部起搏患者组(n=30,女性14(46.7%)例),RVS组为间隔部起搏患者组(n=30,女性13(50%)例),统计并对比基线左室射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs),以及基础疾病情况等资料,对比组间差异。于术后5年召回随访,随访内容有:心脏结构指标:左房内径(LAD)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs);左室功能指标:左室射血分数(LVEF);起搏器程控结果:新发房颤病例数,永久性房颤病例数,心室起搏比例;因心衰入院病人数等。统计患者术后5年期间总心室起搏比例,术后5年LVEF、LAD、LVEDd、LVEDs等,进行组间及组内比较。计量资料以均数±标准差((?)±s)方式表示,组间比较采用t检验;计数资料以百分数方式表示,采用卡方检验进行统计学处理。以P0.05认为差异具有统计学意义。结果:术后5年,两组患者的LAD、LVEDd、LVEDs值较术前有增大趋势,且均有统计学差异(RVA P0.05,RVS P0.05)。两组之间LAD值增大无统计学差异(P0.05)。两组LVEF值均出现具有统计学差异的下降(RVA P0.05,RVS P0.05),组间差异亦有统计学显著性(P0.05),此外,RVA组患者更易出现因心衰住院(P0.05)。两组患者在新发房颤方面差异无统计学显著性。结论:对于左室功能正常的完全性房室传导阻滞患者:1.右室心尖部起搏比右室间隔起搏可对左室结构产生更多的伤害性影响,对左房结构影响无差异;2.右室心尖部起搏比右室间隔起搏对左室功能可产生更多的伤害性影响;3.在右室起搏比例水平相当的条件下,右室间隔起搏与右室心尖部起搏起搏相比,不能降低房颤发生率。
[Abstract]:Objective: artificial cardiac pacing is a routine treatment for patients with complete atrioventricular block. RVA is the traditional site of ventricular electrode implantation, but it may damage cardiac node and function and increase the incidence of postoperative atrial fibrillation. There have been many previous studies comparing RVA pacing with non RVA pacing, but the contradictory conclusions are drawn. The purpose of this study is to compare the effects of non RVA pacing and RVA pacing on cardiac structure and function. To explore whether RVS pacing can produce greater benefits in patients with complete atrioventricular block with normal left ventricular function. Methods: retrospective study was used in this study. From December 2010 to December 2011, 60 patients who were mainly diagnosed as complete atrioventricular block and permanent double chamber pacemaker implantation were randomly selected to exclude the history of atrial fibrillation, heart failure and sinus node disease. Patients with other risk factors of atrial fibrillation and malignant tumors, Two groups of patients were divided into two groups: 1 / RVA group: apical pacing group (n = 30), female group (n = 1446.7) RVS group (n = 30), septal pacing group (n = 30) and female group (n = 1350). The baseline left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-diastolic diameter (LVEDD) were compared and statistically compared. Left ventricular end-systolic diameter (LVEDsN), and basic disease, etc., The differences between groups were compared. After 5 years of recall follow-up, the following items were followed up: cardiac structure index: left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular function index: left ventricular ejection fraction, left ventricular ejection fraction (LVEFN), pacemaker program control result: number of new atrial fibrillation cases, left ventricular function index: left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEF). Number of permanent atrial fibrillation cases, ventricular pacing ratio, number of patients admitted to hospital due to heart failure, etc. The ratio of total ventricular pacing in 5 years after operation and LVEF, LVED, LVED and LVEDs in 5 years after operation were calculated and compared between and within groups. The measurement data were expressed in the form of mean 卤standard deviation) 卤s. T test was used for the comparison between groups, and the counting data was expressed as percentage, and chi-square test was used for statistical processing. P0.05 thought the difference was statistically significant. Results: 5 years after operation, the LVEDDs of the two groups showed an increasing trend compared with those of the patients before operation, and there were significant differences in RVA P0.05 and RVS P0.05. There was no significant difference in LAD between the two groups (P 0.05). There was a statistically significant decrease in LVEF between the two groups. The difference between the two groups was also significant (P 0.05). In addition, the patients in RVA group were more likely to be hospitalized with heart failure (P 0.05). There was no significant difference in new atrial fibrillation between the two groups. Conclusion: in patients with complete atrioventricular block with normal left ventricular function, 1: 1. Right ventricular apical pacing had more noxious effects on left ventricular structure than right ventricular septal pacing, but there was no difference in left atrial structure between right ventricular apex pacing and right ventricular septal pacing. Right ventricular apex pacing has more noxious effects on left ventricular function than right ventricular septal pacing. At the same level of right ventricular pacing, right ventricular septal pacing can not reduce the incidence of atrial fibrillation compared with right ventricular apex pacing.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7

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