心脏置入电子装置对三尖瓣功能的影响

Effect of electronic device implantation on tricuspid valve function

目的：探讨心脏置入电子装置术后对三尖瓣反流的影响因素及可能的发生机制。方法选取置入永久性心脏起搏器、置入式心脏除颤器、临床资料及随访心脏超声资料完整的患者共420例进行回顾性分析，根据术前心脏超声检查三尖瓣反流的程度将患者分为正常组316例与异常组104例，对2组及正常组中单腔起搏器、双腔起搏器、三腔起搏器、置入式心脏除颤器患者的临床资料及心脏超声资料进行比较，并行相关性分析。结果所有患者中，与术前三尖瓣反流面积（T R）／右心房面积（RA ）比较，不同程度三尖瓣反流患者其术后 T R／RA明显升高（ P＜0．01）；与置入心脏再同步心律治疗比较，置入单腔、双腔起搏器患者术后 TR／RA较术前 TR／RA明显升高（P＜0.01）；与术前T R／RA比较，正常组不同程度三尖瓣反流患者术后 T R／RA明显升高（ P＜0．05，P＜0．01）；与0～12个月比较，13～24、25～36和≥37个月术后TR／RA明显升高（P＜0．05，P＜0．01）；Spearman相关分析显示，术后三尖瓣反流程度与术前三尖瓣反流程度、置入起搏器时限、右心房内径、N末端B型钠尿肽呈正相关（ r＝0．405， P＝0．005；r＝0．246，P＝0．005；r＝0．144，P＝0．043；r＝0．153，P＝0．028）。结论无论术前三尖瓣有无反流，心脏电子装置置入术后均可引起不同程度的三尖瓣反流。

Objective To study the effect of electronic device implantation on tricuspid valve regur‐gitation and its mechanism .Methods Four hundred and twenty patients who underwent perma‐nent pacemaker and defibrillator implantation were divided into normal tricuspid valve function group （n=316）and abnormal tricuspid valve function group （n=104） .Their clinical and echocar‐diographic data were compared and analyzed by Spearman correlation analysis .Results The re‐gurgitation area/right atrium area （TR/RA） was significantly higher in tricuspid valve regurgita‐tion patients after operation than before operation （P〈0 .01） ,in patients who underwent single or double‐channel pacemaker implantation than in those who underwent CRTP implantation （P〈0.01） ,in normal tricuspid valve function group after operation than before operation （P〈0 .05 , P〈0 .01） ,and in 13 -24 ,25 -36 and≥37 months than in 0 -12 months after operation （ P〈0.05 ,P〈0 .01） .Spearman correlation analysis showed that the postoperative tricuspid valve re‐gurgitation was positively related with the preoperative tricuspid valve regurgitation ,implanted pacemaker time ,right atrium diameter ,and NT‐proBNP （r= 0 .405 ,P= 0 .005;r= 0 .246 ,P=0.005;r=0 .144 ,P=0 .043 ;r=0 .153 ,P=0 .028） .Conclusion Electronic device implantation can cause different degrees of TR regardless of preoperative tricuspid valve regurgitation .