永久性心脏起搏器86例临床分析

86 implanting permanent pacemakers clinical analysis

目的:分析不同心脏起搏部位及起搏模式对永久性心脏起搏治疗患者心功能及生活质量的影响。方法:入选2004年至2006年行永久性起搏器植入手术的患者86例,其中A组:单腔心室起搏(VVI)心尖起搏组(right ventricle apex RVA)31例;B组:VVI高位室间隔起搏组(right high-interventricular septum RHIVS)8例;C组:双腔心脏起搏(DDD)RVA起搏组38例;D组:DDD RHIVS起搏组9例。分别于起搏治疗前后行心电图、彩色多谱勒超声心动图检查,测量QRS波时限、心脏射血分数(EF)值,左心室舒张末期容积指数(EDVI)和收缩末期容积指数(ESVI),并进行明尼苏达心力衰竭患者生活问卷调查(MLHFQ)。结果:1.单腔起搏器组,无论RVA或RHIVS组术后心功能各项指标(EF、ESVI、ED-VI、MLHFQ)均有下降趋势,A组于术后6个月,B组于术后12个月时出现下降趋势。2.双腔起搏器RVA组于术后12个月时心功能出现下降趋势,而双腔RHIVS组术后与术前比较无明显变化。3.组间比较显示:D组心功能各项指标术后均高于A、B、C组。结论:DDD起搏优于VVI起搏,间隔部起搏明显优于心尖部起搏,特别是DDD间隔部起搏对患者的心功能及生活质量的影响最小,接近于生理起搏。

Objective：To analysis the effect of heart function and quality of life between different site pacing in right ventricule and methods pacing.Methods：Eighty six pacemakers were divided into group A 、group B、group C 、group D.Patients in group A received VVI pacing and permanent pacing in apex of right ventricle,while group B patients received VVI pacing and permanent pacing in septum of right ventricle.group C received DDD pacing and permanent pacing in apex of right ventricle,group D patients received DDD pacing and permanent pacing in septum of right ventricle.The duration of QRS,left ventricular ejection fraction（LVEF）,left ventricular end-diastolic volume index（EDVI）,left ventricular end-systolic volume index（ESVI）,and go into MLHFQ.Results：In VVI group,regardless of RVA or group RHIVS indicators of postoperative heart function（EF,ESVI,EDVI,MLHFQ） have a downward trend.A group at 6 months postoperatively,B group at 12 months.In DDD RVA group,the heart function apear downtrend at 12 months after operation.and DDD RHIVS group,there was no significant statistically in heart function during the whole observation period.Inter-group comparison shows：The heart function indicators of D Group were better than A,B,C group after operation.Conclusion：The DDD method pacing is better than the VVI method pacing,RH IVS is more appropriate for physiologic pacing than RVA.Especially RHIVS of DDD has little negative effect on hemodynamics and quality of life,and may be a better pacing method and site.