右心室流入道间隔部和右心室心尖部起搏神经内分泌激素和心功能的变化

Changes of neuroendocrine hormone and cardiac function in patients treated by right ventricular inflow tract pacing or rght ventricular apical pacing

目的探讨右心室流入道间隔部(RVIS)和右心室心尖部(RVA)起搏治疗缓慢性心律失常神经内分泌激素和心功能的变化。方法房室全能型起搏器(DDD)治疗患者106例,男86例,女20例,年龄45～86岁,平均(76.4±9.5)岁,随机分为右心室流入道间隔部起搏组(RVIS起搏组)56例,右心室心尖部起搏组(RVA起搏组)50例。两组心房电极均植入右心耳梳状肌内,RVIS起搏组心室电极植入右心室流入道间隔部、RVA起搏组心室电极植入右心室心尖部。分别观察两组在起搏器植入时、起搏3个月和6个月不同时期,血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、心钠肽(BNP)和去甲肾上腺素(NE)等神经内分泌激素的含量;应用彩色多普勒超声心动图测定:心排血量(CO)、每搏输出量(SV)、射血分数(EF)和左心室舒张末内径(LVDd)。结果 RVA起搏组治疗后,血浆PRA、AngⅡ、ALD、BNP和NE含量增加,而RVIS起搏组则明显下降;RVIS起搏组心功能改善明显:CO、SV和EF值明显增加,LVDd值缩小,RVA起搏组SV、EF值下降,LVDd增加,CO虽然有所增加,但不如RVIS起搏组明显,差异均有统计学意义(P<0.05)。结论 RVIS起搏优于RVA起搏,可明显改善心功能,纠正神经内分泌激素失调,值得临床推广。

Objective To investigate the changes of neuroendocrine hormone and cardiac function in arrhythmia patients treated by right ventricular inlet septal（RVIS） pacing or right ventricular apical（RVA） pacing.Methods A total of 106 patients treated with DDD pacemaker：male 86 cases and female 20 cases,age 45-86 years,median 76 years,were randomly divided into two groups：RVIS pacing group 56 cases,RVA pacing group 50 cases.In both groups,the atrial electrodes were implanted in the right atrial appendage comb muscles,RVIS ventricular pacing electrode implanted at right ventricular inlet septal,RVA pacing ventricular lead implanted in right ventricular apex.The two groups were observed in the pacemaker implantation,the pacing for three months and six months,the plasma renin activity（PRA）,angiotensin Ⅱ（Ang Ⅱ）,aldosterone（ALD）,cardiac natriuretic peptide（BNP） and norepinephrine（NE） and other neuroendocrine hormone levels were measured;color Doppler echocardiography was used to determine cardiac output（CO）,stroke volume（SV）,ejection fraction（EF） and left chamber end diastolic diameter（LVDd）.Results After treatment,the plasma contents of PRA,AngⅡ,ALD,BNP and NE increased in RVA pacing group,but in RVIS pacing group,they were decreased obviously.In RVIS pacing group,the cardiac function improved：CO,SV and EF value significantly increased,LVDd value reduced,while in RVA pacing group,SV,EF value fell,LVDd increased,CO although increased,it was not as obvious as RVIS pacing group,the difference was statistically significant（P〈0.05）.Conclusion Compared with RVA pacing,RVIS pacing can significantly improve cardiac function,correct the imbalance of neuroendocrine hormones,it is worthy of promotion.