植入心脏起搏器患者死亡原因分析

Analysis of late cause of death in patients implanted with pacemakers

目的分析永久心脏起搏器植入患者的远期死亡原因及相关因素。方法对我院植入永久心脏起搏器401例的手术及随访资料进行回顾性研究。结果死亡91例,病死率22.7%;死亡原因前3位依次为心力衰竭30例(7.5%)、脑卒中17例(4.2%)和心源性猝死16例(4.0%);对死亡原因进行分析,心脏扩大和单腔心室(VVI)起搏方式与心力衰竭和心源性猝死死亡原因有关。此外,心力衰竭死亡的相关因素还有累计心室起搏百分比(Cum%VP)>40%以及术前存在房室传导阻滞(AVB)(P<0.05);与心源性猝死相关的因素还有冠心病史和术前发生过室性心动过速(VT)或心室颤动(VF)(P<0.05);而脑卒中死亡则与术前脑血管病史和心房纤颤(AF)有关(P<0.05);各死亡组在年龄、性别的分布上均无统计学意义(P>0.05)。结论植入永久心脏起搏器患者的远期死亡原因的前3位依次是心力衰竭、脑卒中和心源性猝死,并分别与VVI起搏方式、Cum%VP、术前存在心脏扩大、AVB、VT、VF、AF以及冠心病和脑血管病等因素有直接关系。

Objective To analyse the late cause of death and correlated factor in the patients implanted with the pacemaker. Methods Operations and follow-up clinical materials of 401 patients who were implanted with the permanent pacemaker in the hospital were reviewed. Results There were 91 died patients with mortality rate 22.7%. The causes of death were in turn heart failure 30 cases （7.5 % ）, apoplectic stroke 17 cases （4.20% ）, and sudden cardiac death 16 cases（4.0%）,which occupied on the three casualties. Analysis about the causes of death indicated that heart enlargement and pacing way with single cavity had a relation with the causes of the heart failure and sudden cardiac death. In addition, the correlated factors of death in the patients with heart failure were the cumulative percent ventricular pace（Cum% VP） 〉40%, as well as the atrium-ventricle conduction block（AVB） before operation（ P〈0.05）. Sudden cardiac death was relating with coronary heart disease and ventricular tachycardia（VT） or ventricular fibrillation（VF） before operation （P 〈0.05）. Death from apoplectic stroke was related with stroke and auricular fibrillation（AF） before operation （ P 〈0.05）. There were no statistic significances about the distribution of age and sex between death groups（ P 〉0.05）. Conclusion The first three causes of death in the patients implanted with permanent pacemaker are in turn heart failure, apoplectic stroke and sudden cardiac death, which have positive relation with the pacing way with VVI, Cure % VP, heart enlargement, AVB, VT, VF, AF, coronary heart disease and stroke before operations.