美托洛尔在DDD型起搏器治疗三度房室传导阻滞患者中的应用

发布时间：2018-06-24 02:14

本文选题：美托洛尔 + 起搏器　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景三度房室传导阻滞患者,心室对起搏器完全依赖,长期高比例的右心室起搏,导致心室不同步,类似于左束支传导阻滞,对心脏结构和功能产生不利影响,恶化患者的心功能,增加心房颤动、心力衰竭发生率,甚至增加死亡率。右室心尖部起搏作为心室经典的起搏部位,在过去20年里,长期右室心尖部起搏相关的负面报道逐渐引起重视。对此,专家学者们提出改变心室电极植入位置避免长期高比例心室起搏对心功能的影响,如右室间隔部及希氏束起搏等。然而,右室心尖部因植入经验丰富、操作简单、易于固定等优点,沿袭数十年至今依然作为常规的心室起搏部位。因此,右室心尖部起搏在临床上仍占据一定的比例,但长期高比例右室心尖部起搏对于心功能的影响需格外关注。目前关于药物能否改善长期高比例右室心尖部起搏患者预后的研究甚少。美托洛尔是选择性β1受体阻滞剂,通过抑制肾素-血管紧张素-醛固酮系统(RASS),延缓心肌重构,改善心功能,降低心脏不良事件的发生率。目的研究美托洛尔对DDD型起搏器治疗三度房室传导阻滞患者心功能、房颤负荷及QT间期离散度的影响。方法1.对象及分组连续纳入2013年9月至2016年3月我院心内科收治的三度房室传导阻滞择期行永久双腔起搏器植入术的患者127例。根据起搏器术后1周是否应用美托洛尔分为观察组与对照组,其中应用美托洛尔即观察组53例,对照组74例。2.一般临床资料两组患者的年龄、性别、合并症、药物使用等一般情况,以及起搏器术后1周左房内径、左室舒张末内径、左室射血分数、心率、QT间期离散度、血BNP等,将起搏器术后1周的辅助检查指标作为基线参考数据。3.随访及疗效评价每位患者至少随访1年,采集程控数据信息,心脏彩超参数,QT间期离散度及BNP等。4.统计分析应用SPSS 20.0统计分析软件,计量资料比较采用t检验,两独立样本方差齐性检验采用Levene's test;计数资料采用χ2检验;p0.05为差异有统计学意义。结果1.一般临床资料比较对照组患者血脂异常较观察组患者检出率高(55.4%vs 35.8%,p0.05),余基线指标无统计学差异。2.术后6个月观察组及对照组两组分别与同组基线比较,房颤负荷均增加(p0.05)。对照组心室率增加,而观察组患者心率降低(p0.05).3.术后1年(1)与同组基线组比较,观察组患者左室舒张末容积(LVEDD)、房颤负荷增加,心室率降低(P均0.05);对照组患者与同组基线组比较,左房内径(LAD)、左室舒张末内径(LVEDD)、BNP、房颤负荷、心室率、QTd增加(P均0.05)。(2)两组左室射血分数(LVEF)与同组基线比较差异均无统计学意义(P均0.05)。(3)对照组△左房内径(LAD)、△左室舒张末内径(LVEDD)、△房颤负荷(AFB)、△心室率(HR)及△ QT间期离散度变化量较观察组明显(P均0.05)。(4)两组射血分数变化量无统计学差异(P0.05)。4.两组患者不良事件发生率比较观察组患者室速发生率较对照组低,差异有统计学意义(p0.05)。两组患者低血压及呼吸困难的发生率无统计学差异(p0.05)。结论本研究我们得出以下几点结论:1.长期高比例(至少持续1年)右心室心尖部起搏会使患者左房左室扩张、房颤负荷及QT间期离散度增加。2.应用美托洛尔可改善患者一般临床状况,改善长期高比例右心室心尖部起搏患者的左房室扩张,降低房颤负荷及QT间期离散度等。3.两组患者左室射血分数无差异,可能与起搏器治疗周期短,尚未对射血分数造成明显影响有关。4.美托洛尔改善长期高比例右室心尖部起搏患者的远期预后,并且不增加不良事件发生率。
[Abstract]:Background three patients with atrioventricular block, ventricles are completely dependent on pacemakers, long and high proportions of right ventricular pacing, leading to ventricular asynchrony, similar to left bundle branch block, adverse cardiac structure and function, worsening cardiac function, increased atrial fibrillation, heart failure rate, and even increase death rate. Right ventricle Apical pacing, as the classical pacing site of the ventricle, has been paid more and more attention in the past 20 years. For this reason, experts and scholars have proposed to change the position of ventricular electrode implantation to avoid the effect of long-term high proportion of ventricular pacing on cardiac function, such as the right ventricular septum and hash pacing. The apex of the ventricular apex has the advantages of rich experience, simple operation and easy fixation. It is still used as a conventional ventricular pacing site for decades. Therefore, right ventricular apex pacing still occupies a certain proportion in clinical, but the long-term high proportion of right ventricular apex pacing should be paid more attention to the effect of cardiac function. To improve the prognosis of patients with long-term and high proportion right ventricular apex pacing, metoprolol is a selective beta 1 receptor blocker, by inhibiting the renin angiotensin aldosterone system (RASS), delaying cardiac remodeling, improving cardiac function and reducing the incidence of adverse cardiac events. Objective to study the treatment of three degrees by metoprolol in the treatment of DDD pacemaker. The effects of ventricular conduction block on cardiac function, atrial fibrillation load and QT interval dispersion. Methods 1. subjects and groups were consecutively included in 127 cases of three degrees atrioventricular block in Department of Cardiology of our hospital from September 2013 to March 2016 with permanent double chamber pacemaker implantation. The application of metoprolol was observed at 1 weeks after the pacemaker operation. The group and the control group were treated with metoprolol, 53 cases of the observation group, 74 cases of.2. general clinical data in the control group, the age, sex, complication and drug use, as well as the left atrial diameter, the left ventricular end diastolic diameter, the left ventricular ejection fraction, the heart rate, the QT interval dispersion, the blood BNP, and the 1 weeks after the pacemaker operation. As baseline reference data.3. follow-up and therapeutic evaluation, each patient was followed up for at least 1 years. The data of program controlled data, cardiac color Doppler parameters, QT interval dispersion and BNP and other.4. statistical analysis were applied to SPSS 20 statistical analysis software. The measurement data were compared with t test, and Levene's test was used in two independent sample variance homogeneity test. The count data were tested with chi 2 test, and P0.05 was statistically significant. Results 1. general clinical data compared with the control group, the blood lipid abnormality was higher than that in the observation group (55.4%vs 35.8%, P0.05), and there was no statistical difference in the residual baseline index. The 6 months after.2. operation and the control group two groups were compared with the same group baseline, the atrial fibrillation load increased (P 0.05) the ventricular rate in the control group was increased, while the rate of heart rate decreased (P0.05) in the observation group was 1 years after.3. (1), compared with the same group, the left ventricular end diastolic volume (LVEDD), the atrial fibrillation load increased and the ventricular rate decreased (P 0.05) in the observation group. Compared with the same group, the left atrial diameter (LAD), the left ventricular end diastolic diameter (LVEDD), BNP, and atrial fibrillation were negative in the control group. Charge, ventricular rate and QTd increased (P 0.05). (2) there was no significant difference between the two groups of left ventricular ejection fraction (LVEF) and the same group (P 0.05). (3) Delta left atrium diameter (LAD), delta left ventricular end diastolic diameter (LVEDD), delta atrial fibrillation load (AFB), delta ventricular rate (HR) and delta dispersion (P 0.05). (4) two groups (4) two groups There was no statistical difference in the change of ejection fraction (P0.05) the incidence of adverse events in group.4. two patients was lower than that in the control group, the difference was statistically significant (P0.05). There was no statistical difference between the two groups of patients with hypotension and dyspnea (P0.05). Conclusion we concluded the following conclusions in this study: 1. long term high The ratio (at least 1 years) of the right ventricular apex pacing will make the left ventricular left ventricle dilated, atrial fibrillation load and QT interval dispersion increase by.2. application metoprolol can improve the general clinical status of patients, improve the left atrioventricular dilatation, lower atrial fibrillation load and QT interval dispersion in the long term high proportion of right ventricular apex pacing patients, and improve the patient's left atrioventricular dilatation, lower atrial fibrillation load and QT interval dispersion. There is no difference in left ventricular ejection fraction, which may be short of the pacemaker period, and has not significantly affected the ejection fraction of.4. metoprolol to improve the long-term prognosis of the long-term and high proportion of right ventricular apical pacing patients, and does not increase the incidence of adverse events.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7

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