右室不同部位起搏对左房收缩功能及血脑钠肽的影响

发布时间：2019-01-23 09:48

【摘要】：目的:运用超声心动图(ultrasonic cardiogram,UCG)评价右室心尖部(right ventricular apical,RVA)起搏及右室间隔部(right ventricular septal,RVS)起搏对完全性房室传导阻滞患者左室、左房收缩功能的影响,并观察两组患者的血浆脑钠肽(brain natriuretic peptide,BNP)水平的变化,研究植入埋藏式心脏起搏器术后左室收缩功能与血浆BNP之间是否具有相关性。方法:将具备埋藏式心脏起搏器植入适应证的51例完全性房室传导阻滞患者随机分为RVA起搏组(RVA组,20例)和RVS起搏组(RVS组,31例),分别于术前、术后1、3、6及12个月采用二维超声心动图Simpson法测定所有患者的左室射血分数(ejection fraction of left ventricle,LVEF)及左房射血分数(ejection fraction of left atrial,LAEF),同时测定患者血浆BNP值。结果:两组LVEF术后12个月较术前、术后1个月、术后3个月有所恢复(P0.01);两组LAEF术后6个月、12个月较术前、术后1个月、术后3个月有所恢复(P0.01);RVS组术后6个月、12个月LAEF恢复程度优于RVA组(P0.01);RVS组术后12个月LVEF恢复程度优于RVA组(P0.01)。所有患者LVEF与BNP水平呈负相关(r=-0.51,P0.05)。RVS组术后BNP水平低于RVA组(P0.01),RVS组术前、术后BNP水平不同时间点之间有差异(P0.01)。结论:RVS起搏较RVA起搏更有利于左室及左房射血功能恢复,可能是更为理想的右室起搏部位。血浆BNP水平与LVEF具有相关性,可在一定程度上反映心脏起搏器安置术后患者左室收缩功能的恢复情况。
[Abstract]:Objective: to evaluate the effects of right ventricular apex (right ventricular apical,RVA) pacing and right ventricular septal (right ventricular septal,RVS) pacing on left ventricular and left atrial systolic function in patients with complete atrioventricular block by echocardiography (ultrasonic cardiogram,UCG). The changes of plasma brain natriuretic peptide (brain natriuretic peptide,BNP) levels in two groups were observed to investigate the correlation between left ventricular systolic function and plasma BNP after implantation of implantable pacemaker. Methods: Fifty-one patients with complete atrioventricular block were randomly divided into RVA pacing group (RVA group, n = 20) and RVS pacing group (RVS group, n = 31). Left ventricular ejection fraction (ejection fraction of left ventricle,LVEF) and left atrial ejection fraction (ejection fraction of left atrial,LAEF) were measured by two-dimensional echocardiography (Simpson) and plasma BNP at 6 and 12 months. Results: LVEF in both groups recovered 12 months after operation, 1 month after operation, 3 months after operation (P0.01), 6 months, 12 months after operation, 1 month after operation and 3 months after LAEF in both groups (P0.01). The recovery degree of LAEF in RVS group was better than that in RVA group at 6 months and 12 months after operation (P0.01); RVS group was better than RVA group in LVEF recovery at 12 months after operation (P0.01). There was a negative correlation between LVEF and BNP level in all patients (r-0.51p0.05 BNP level in). RVS group was lower than that in RVA group (P0.01), RVS group, there was significant difference in BNP level between different time points after operation (P0.01). Conclusion: RVS pacing is more beneficial to the recovery of left ventricular and left atrial ejection function than RVA pacing, and may be a more ideal right ventricular pacing site. Plasma BNP level was correlated with LVEF, which could reflect the recovery of left ventricular systolic function after pacemaker implantation.
【作者单位】：贵州省人民医院心内科;
【基金】：贵州省优秀科技教育人才省长专项资金资助项目(No:2012-12) 贵州省卫生计生委科学技术基金(No:GZWKJ2014-1-047)
【分类号】：R541.7

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