频率适应型双腔起搏器对男性Ⅲ度房室传导阻滞患者运动耐量和性生活质量的影响

Effect of rate adaptive dual-chamber pacemaker on exercise capacity and quality of sexual activity in male patients with third-degree atrioventricular block

目的观察频率适应型双腔起搏器（DDDR型起搏器）对男性Ⅲ度房室传导阻滞患者运动耐量和性生活质量的影响。方法选择2008年8月至2012年8月在商丘市第一人民医院住院治疗的Ⅲ度房室传导阻滞患者共计170例。根据有无植入DDDR型起搏器分组为对照组（64例）和DDDR组（106例）。采用国际男性性功能判断指数（IIEF-5）量表观察治疗前后患者性功能评分，调查治疗前及治疗后6个月性功能评分；统计每个月患者性交次数。运动耐量和心功能评价采用6min步行试验和超声心动图，6min步行试验结束时测量患者心率、步行距离，超声心动图测量左心室射血分数，计算心输出量。结果DDDR组较对照组治疗后IIFE-5总评分、性交满意度、性交次数明显增加[（20±6）分比（16±5）分，（4．6±1．3）分比（2．6±1．6）分，（6．1±2．9）次／月比（3．4±1．7）次／月]，差异有统计学意义（P＜0．05）。DDDR组较对照组治疗后6min步行试验步行距离、心率、心输出量明显改善[（528±106）m比（379±75）m，（127±9）次／min比（51±8）次／min，（4．8±0．7）L／min比（3．9±0．5）L／min]，差异有统计学意义（P＜0．05）。结论DDDR型起搏器对于男性Ⅲ度房室传导阻滞患者运动耐量和性生活质量有明显的改善作用，其机制主要是起搏器植人增加雷耍肺器及组织的供向和件毕活时的运动耐量。

Objective To investigate the effect of rate adaptive dual-chamber pacemaker on exercise capac- ity and quality of sexual activity in male patients with third-degree atrioventricular block. Methods We randomly assigned 170 male patients with third-degree atrioventrieular block to DDDR group（ n = 106） and control group（ n = 64）. At the baseline and post treatment, we assessed the international index of erectile function （ IIEF-5 ） and fre- quency of sexual activity. At the same time, 6 min walking test （6MWT） was recorded. The distance and heart rate of 6MWT were measured; left ventrieular ejection fraction （LVEF） and cardiac output were also calculated. Results Compared with the control group, The IIEF-5 score, sexual satisfaction and frequency of sexual activity [（20±6）scoresvs （16±5）scores,（4.6±1.3）scores vs （2.6 ±1.6）scores, （6. 1 ±2.9）times/month vs （3.4 ± 1.7 ）times/month] had a significant increase in DDDR group after treatment（ P 〈 0.05 ）. Compared with the control group, the distance and heart rate of 6MWT and cardiac output in DDDR group significant increased [ （528 ± 106 ） m vs （ 379 ± 75 ） m, （ 127 ± 9 ） times/min vs （ 51± 8 ） times/min, （4.8 ± 0.7 ） times/rain vs （ 3.9 ± 0.5 ） times/rain] ; there was a significant difference between the DDDR group and control group （ P 〈 0. 05 ）. Conclusions Among male patients with third-degree atrioventricular block, those treated with DDDR have improve- ments in exercise capacity and quality of sexual activity than control group. These improvements are positively asso- ciated with increases in exercise capacity during sexual intercourse.