影响双腔心脏起搏器寿命的相关因素研究

The research of related factors affecting the longevity of double chamber cardiac pacemaker

目的探讨影响双腔心脏起搏器(PM)寿命的有关因素,为双腔PM的合理应用和设计提供临床依据。方法自1991年始,对使用双腔PM的71例患者进行随访观察。从患者安装PM起,即对每例PM的感知电流、起搏电压和阻抗等有关起搏参数进行定期观察记录。到2005年观察终点,按照患者性别、年龄、诊断以及PM每种起搏参数的不同数值分别进行分组,对可能影响双腔PM寿命的有关参数进行统计学处理。结果双腔PM的平均使用寿命为111个月±19个月。单因素统计分析显示:患者基础心率、电池容量、起搏电压、起搏频率、阻抗、阈值、脉宽和感知电流对PM的寿命均有影响(均P<0.05)。Cox比例风险回归分析显示:感知电流[P=0.000,相对危险度(RR)=3.072,95%可信区间(CI)=2.130～4.429],起搏电压(P=0.040;RR=2.121,95%CI=1.126～3.998),阻抗(P=0.049,RR=1.786,95%CI=1.007～3.169)为重要的PM寿命预测指标。结论感知电流、起搏电压和阻抗是影响双腔PM寿命的重要因素,患者基础心率、电池容量、阈值、起搏频率和脉宽对双腔PM的使用寿命也有不同程度的影响。

Objective To research the related factors affecting the dual chamber cardiac pacemaker（PM） longevity, and provide the clinical basis for the PM reasonable application and design. Methods From 1991,71 patients with AVB or SSS who used 9 kinds of dual-chamber PM were followed up. Every installed PM＇s related parameters, such as sensing electric current, resistance and pacing electric voltage,which may affect the PM longevity voltage had been recorded regularly. At the end point of survey, according to the related parameters of patients and PMs, the 71 patients were grouped into several groups. Then the related parameters were analyzed by statistical methods. Results The average of PM service life is 111 months ± 19 months. Patient＇s basal heart rate, battery capacity , pacing electric voltage,pacing frequency,resistance,threshold value,pulse width and sensing electric current had all affected the PM＇s longevity （ all P 〈 0. 05 ） counted by Wilcoxon （Gehan） test. Sensing electric current （ P = 0. 000, RR = 3.072,95 % CI =2. 130-4. 429）, pacing electric voltage （P =0. 040, RR =2. 121,95% CI = 1. 126-3. 998） and resistance （P= 0.049, RR = 1.786,95% CI = 1.007-3. 169） were the important predicting indictors of the PM longevity by Cox＇proportional hazard risk regression analysis. Conclusion Sensing electric current, pacing electric voltage and resistance are the important affecting factors of the PM longevity . Patient＇s basal heart rate ,battery capacity, pacing frequency, threshold value and pulse width have influence of different degree on dual-chamber PM longevity.