优化AV间期对伴有二尖瓣反流的双腔起搏器植入患者效应观察

发布时间：2018-07-07 08:57

本文选题：双腔起搏器 + AV间期　；参考：《临床心血管病杂志》2017年10期

【摘要】：目的:因完全性房室传导阻滞植入双腔起搏器(DDD)患者日益增多,通过起搏器参数调整可改善心功能,提高生活质量。本研究分析伴有二尖瓣反流(MR)的DDD植入者,短期和长期在最佳房室间期(AVI)是否能改善MR、增加每搏输出量(SV)。方法:对2010~2013年的30例植入DDD伴MR的患者随机分为程控组(16例)和对照组(14例),起搏频率均为70次/min。术后2d程控组在心脏超声监测下程控起搏器,达到最佳AVI,即反流程度[反流容量(RV)、分数(RF)以及面积(RA)]减少和SV增加,并在术前、术后2d和3个月随访LVEF、BNP和NYHA分级等。结果:术后2d,在最佳AVI[(96±11)ms]内,程控组中MR程度减少和SV增加(P0.01);程控组与对照组相比亦有同样变化(P0.01)。术后3个月与术后2d相比程控组无进一步的MR减少和SV增加(P0.05);而LVEF、BNP、NYHA分级、6min步行距离、再住院率和病死率差异亦无统计学意义。结论:缩短AVI可以减少MR程度并增加每分输出量,改善心功能,但最佳AVI个体差异大。本研究随访时间短,全起搏所带来的远期效应并不明确,需要长期随访及大量临床试验进一步研究。
[Abstract]:Aim: to improve cardiac function and quality of life by adjusting pacemaker parameters due to the increasing number of patients with complete atrioventricular block implanted dual chamber pacemaker (DDD). This study analyzed whether DDD implants with mitral regurgitation (Mr) could improve MRs and increase stroke output (SV) in the short and long term at optimal atrioventricular interval (AVI). Methods: from 2010 to 2013, 30 cases of DDD with Mr were randomly divided into programmed control group (16 cases) and control group (14 cases). The pacing frequency was 70 times / min. On the 2nd day after operation, the programmed pacemakers were monitored by echocardiography to achieve the best AVI, i.e., the degree of regurgitation [RV, RF and area (RA)] was decreased and SV was increased. The patients were followed up before operation, 2 days and 3 months after operation for LVEFU BNP and NYHA grading. Results: in the optimal AVI [(96 卤11) Ms] on the 2nd day after operation, the degree of Mr was decreased and SV increased (P0.01) in the program-controlled group, and the same change was found in the program-controlled group compared with the control group (P0.01). There was no significant difference in Mr and SV between 3 months after operation and 2 days after operation (P0.05), but there was no significant difference in walking distance, rehospitalization rate and mortality between LVEFV BNPN NYHA classification and 6 min walking distance. Conclusion: shortening AVI can reduce Mr degree, increase output per minute and improve cardiac function. The duration of follow-up is short and the long-term effect of total pacing is not clear. It needs long-term follow-up and a large number of clinical trials for further study.
【作者单位】：重庆医科大学附属第一医院心内科;
【分类号】：R541.7

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