不同心功能分级患者心脏起搏后血液B型利钠肽水平变化

Changes of blood B-type natriuretic peptide in patients with different heart functional class

目的观察不同心功能分级患者心脏起搏后血液B型利钠肽(BNP)水平变化。方法分别测定105例心脏永久起搏患者术前;术后1日、1周;1,3,6,9个月BNP水平,比较不同时期不同起搏方式下BNP水平变化。对32例DDD(R)起搏患者,起搏9个月后分别改DDD(R)起搏方式为AAI(R)和VVI(R)起搏2个月,并测定BNP水平。结果术前心功能Ⅰ-Ⅱ级患者,术前及术后不同随访时期生理性起搏与非生理性起搏BNP水平无显著变化(P>0.05);术前心功能Ⅲ-IV级患者,术前及术后不同随访时期生理性起搏与非生理性起搏BNP水平差异有显著性(P<0.05),生理性起搏时BNP水平较非生理性起搏下降,AAI(R)起搏后BNP的水平较DDD(R)下降,DDD(R)起搏后BNP的水平较VVI(R)下降。结论对缓慢性心律失常需行心脏永久起搏患者如同时合并心功能不全,宜首选生理性起搏,如患者房室传导功能正常则以AAI(R)起搏方式最佳。

Objective To observe changes of blood B-type natriuretic peptide（BNP） in patients with different heart functional class. Methods BNP levels of 105 patients with permanent cardiac pacing were assayed before operations and 1 day, 1 week ; 1,3, 6 and 9 months postoperatively. BNP level changes were compared in different periods and different pacing modes. DDD（R） pacing was performed in 32 patients and changed to AAI（R） and VVI（R） pacing for 2 months respectively after 9 months in DDD （R） pacing, and then patients＇ BNP levels were assayed. Results For patients with heart functional class Ⅰ-Ⅱ before operations, BNP level changes were not significant between physiologic and non-physiologic pacing in pre-operation and different periods of post-operation. For patients with heart functional class Ⅲ-Ⅳ before operations, BNP level changes were remarkable between physiologic and non-physiologic pacing in pre-operation and different periods of post-operation, and BNP levels in physiologic pacing were decreased than those in non-physiologic pacing. BNP levels in AAI（R） pacing were decreased than those in DDD（R） pacing, and BNP levels in VVI（R） pacing were higher than those in DDD（R） pacing. Conclusions Physiologic pacing should be the first chosen to patients with bradycardia and congestive heart failure （CHF）, and AAI （R） is the best pacing mode if patients＇ atrioventricular conduction function is normal.