不同起搏部位对左心室功能影响的对比研究

Comparison of Effects of Different Parts of Ventricular Pacing on Left Ventricular Function

目的对比不同起搏部位对左心室功能影响。方法将植入永久心脏起搏器手术患者130例根据起搏部位不同分为A组(右室心尖部,35例)、B组(右室高位间隔面,25例)、C组(右室中位间隔面,28例)、D组(右室低位间隔面,32例)。比较四组患者术前和术后1.5年左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、血清N端B型脑钠肽前体(NT-pro BNP)、QRS波群时限、心血管事件发生情况。结果与术前比较,A组术后1.5年LVEF降低(P<0.05),A、D组患者术后LVEDV有不同程度增加;术后1.5年四组患者LVEDV比较,A组最大(P<0.05)。与术前比较,A、B、D组术后NT-pro BNP均有不同程度增加;术后1.5年四组患者NT-pro BNP比较,A组最大(P<0.05)。术后1.5年四组患者QRS波群时限比较,A组最宽,C组最窄(P<0.05)。C组患者心血管事件发生率(3.6%)低于A组(40.0%)及D组(21.9%)(P<0.05)。结论右室中位间隔面起搏对左心室功能影响小,心血管事件发生率低,可作为植入永久心脏起搏器的最佳部位。

Objective To compare the effects of different parts of ventricular pacing on left ventricular function. Methods 130 patients with implantation of permanent pacemaker were divided into 4 groups according to the different pacing sites,group A( apex of right ventricle,n = 35),group B( high right ventricular septal surface,n = 25),group C( middle right ventricular septal surface,n = 28),group D( low right ventricular septal surface,n = 32). Left ventricular ejection fraction( LVEF),left ventricular end diastolic volume( LVEDV),serum N terminal B type natriuretic peptide precursor( serum NT-pro BNP),QRS wave duration,incidence of cardiovascular event of patients in the four groups before and 1. 5 years after operation were compared. Results Compared to patients before operation,patients in group A had lower LVEF 1. 5 years after operation( P <0. 05). Compared to patients before operation,patients in group A and group D had higher LVEDV 1. 5years after operation.Group A had the highest LVEDV of patients among the four groups( P < 0. 05). Compared to patients before operation,patients in group A,B and D had higher NT-pro BNP. Group A had the highest NT-pro BNP of patients among the four groups( P< 0. 05). Group A had the widest QRS wave duration of the four groups while group C had the narrowest( P < 0. 05). The incidence of cardiovascular event of patients in group C( 3. 6%) was lower than that in group A( 40. 0%) and group D( 21. 9%,P < 0. 05). Conclusions The right ventricular septal surface in median had low influence in left ventricular function and low incidence of vascular events and can be the best part of implantation of permanent pacemaker.