AAI、DDD起搏方式对病窦综合征患者血流动力学及神经内分泌因子的影响

Effect of Pacing Mode(AAI vs DDD) on Hemodynamic and Neuroendocrine in Patients with Sick Sinus Syndrome

目的:探讨AAI与DDD起搏方式对病窦综合征(SSS)患者血流动力学及神经内分泌因子的影响。方法:20例因SSS入院并植入双腔起搏器的患者,先以DDD方式起搏1周,再以AAI方式起搏1周。记录不同起搏方式下QRS波宽度、起搏方式调整即刻血流动力学的变化,并检测不同起搏方式起搏1周后神经内分泌因子的变化。结果:(1)DDD模式下QRS波较AAI模式下增宽,差异有统计学意义(P<0.05)。(2)主动脉血流速度时间积分(AVTI)在DDD模式下较AAI模式下降低,差异有统计学意义(P<0.01)。(3)与AAI模式相比DDD模式造成神经内分泌因子心钠素(ANP)、内皮素(ET)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)升高,差异有统计学意义(P<0.05或P<0.01)。结论:与AAI起搏方式相比DDD起搏方式短期即可造成神经内分泌激活,并影响左室功能。

Objective：To investigate the effect of pacing mode（AAI vs DDD） on the hemodynamic and neuroendocrine in patients with sick sinus syndrome（SSS）.Methods：Twenty patients with SSS were selected for the study.The patients were all implanted DDD pacemakers.They were programmed DDD mode after operation.One week later they were programmed AAI mode.The widths of electrocardiographic QRS wave and the hemodynamic parameter at the mode changes were measured,including left ventricular ejection fraction（LVEF）,E peak,A peak and the asynchrony of left ventricular.The levels of atrial natriuretic factor（ANP）,endothelin（ET）,angiotensin;angiotensin Ⅱ（AngⅡ） and aldosterone（ALD） were detected in different modes.Results：The width of QRS was significantly wider in DDD mode than that in AAI mode（P 〈0.05）.Aortic blood flow velocity time integral（AVTI） was significantly higher in AAI mode than that of DDD mode（P〈 0.01）.The levels of plasma ANP,ET,AngⅡand ALD were significantly higher in patients with DDD mode than those of AAI mode.Conclusion：Compared with AAI mode,DDD mode activates neuroendocrine in short term and has adverse effect on left ventricular function.