生理性与非生理性起搏方式并发症的对比分析

Comparison of complications after VVI versus physiological pacing

目的探讨生理性与非生理性起搏并发症及对患者预后的影响。方法对两种起搏方式６７３例（非生理性起搏５２５例，生理性起搏１４８例）患者的并发症进行回顾性对比分析。随访时间最长２２年３个月，最短１个月。结果两种起搏方式并发症总发生率差异无显著性，非生理性起搏组并发症发生率为２０．１％，生理组为１９．６％（Ｐ＞０．０５）。非生理性起搏组起搏器综合征发生率为４．２％、心房颤动发生率为６．９％，高于生理组的０％（Ｐ＜０．００１），脑梗塞发生率为２．５％；生理组无起搏器综合征、心房颤动发生，脑梗塞发生率仅为０．１％，本组并发症主要为感知过度及起搏器介入性心动过速（ＰＭＴ），其发生率均为７．４％，高于非生理组的１．１％（Ｐ＜０．０１），ＰＭＴ为本组所特有并发症。结论生理组并发症多因起搏器调整不当所引起，对患者预后影响不大，通过调整起搏器可得到解决［１］。非生理性起搏并发症多与血液动力学改变有关，这些并发症影响患者生活质量及预后，部分患者需更换起搏方式。

bjective To compare the complication rate in patients with physiological pacing versus VVI pacing. Methods 673 consecutive procedures performed during more than 22 year period were analyzed retrospectively,525 patients (82%) received a VVI pacemaker and 148 patients (22%) a physiological pacemaker(DDD,AAI,VDD).Results Physiological pacing group had a complication rate of 19.6%,and VVI pacing group had a complieation rate of 20.1%.There was no significant difference of total complication rate between these two groups.Pacemaker syndrome happened in 4.2%,atrial fibrillation in 69%,stroke in 2.5% of patients with VVI pacemaker.Oversensing and pacemaker mediated tachycardia occurred in 7.4% and stroke in 01% of patients with physiological pacing.HZConclusion The complications occurred in the patients with physiological pacemaker mainly due to the inappropriately programmed pacing parameters.They can be corrected by means of reprogramming the pacing parameters and did not lead to grave consequences to the patients.The complications developed in patients with VVI pacemaker were due to the asynchronousness of the pacing mode.It could result in hemodynamic disorders of the patients and the VVI pacemaker had to be replaced by a physiological pacing system in some patients.