对安置起搏器病人在不同心脏起搏模式下生活质量的评价

Evaluation on quality of life of patients installed pacemaker under different cardiac pacing modes

[目的]探讨不同心脏起搏模式下病人生活质量状况。[方法]选取均能进行日常活动且植入全自动双腔起搏(DDD)型或全自动双腔起搏频率适应(DDDR)型起搏器的Ⅲ度房室传导阻滞且窦房结功能正常(32例)和病窦综合征(心房、心室感知均≤10%)(51例)病人83例,进行前瞻性、随机、交叉、双盲对照研究,对起搏器随机程控为不同模式各1个月,在每种模式末,所有病人均填写Hacetepe生活质量问卷和Karolins-ka生活质量问卷中心血管症状学问题问卷。[结果]Ⅲ度房室传导阻滞且窦房结功能正常的病人,与心室起搏感知频率适应(VVIR)模式相比,DDD起搏模式下,心血管症状和生活质量显著改善;病窦综合征病人,与DDD模式相比,DDDR、VVIR起搏模式时,心血管症状和生活质量显著改善;与VVIR模式相比,DDDR起搏模式时,心血管症状和生活质量总分显著改善,但心血管症状和生活质量各维度的改善均无统计学意义。[结论]Ⅲ度房室传导阻滞且窦房结功能正常的病人,DDD模式是较佳的起搏模式;病窦综合征(心房、心室感知均≤10%)病人,DDDR模式是最佳的起搏模式。

Objective： To probe into the quality, of life of patients installed pacemaker under different pacing nodes. Methods：A total of 32 cases of third- degree atrioventricular block patients undergone type DDD or DDDR pacers who can endure daily activities and whose sinus node function were normal and another 51 cases with sick sinus syndrome （S S S） （whose atrium and ventricle apperception were ≤10 % ） were selected. The prospective, random, crossover, double blind controlled study on all 83 patients had performed. Pacers were randomly programmed control into different modes （1 month for each mode）. At the end of each mode, all patients were asked to fill out cardiovascular semeiologic questionnaires of Hacetepe quality of life questionnaire and Karolinska quality of life questionnaire. Results： Compared to VVIR mode, under the DDD pacing mode, cardiovascular symptoms and quality of life of third- degree atrioventricular block patients with normal sinus node function were significantly improved. Compared to DDD mode, adopting DDDR and VVIR pacing modes, cardiovascular symptoms and quality of life of 51 SSS patients were significantly improved. And compared to WlR mode, adopting DDDR pacing mode, the total scores of both cardiovascular symptoms and quality of life of 51 SSS patients were significantly improved. However, there were no statistical significant differences in terms of each dimension of cardiovascular symptoms and quality of life improvement among SSS cases. Conclusion： For third - degree atrioventricular block patients with normal sinus node function, DDD mode is a better pacing mode. For SSS patients （atrium and ventricle apperception ≤10% ）, DDDR is the best pacing mode.