右室不同部位起搏对血浆氨基末端脑钠肽前体水平及左心收缩功能的影响

The effects of different pacing sites of right ventricle on serum N-terminal Pro brain natriuretic peptide level and left ventricular systolic function

目的 探讨右室不同部位起搏对起搏依赖患者血浆氨基末端脑钠肽前体（NT-ProBNP）水平及左心收缩功能的影响. 方法 选择植入双腔起搏器的患者76例,按心室电极固定部位不同随机分为右室心尖部起搏组36例及右心室间隔部起搏组40例.观察两组术前与术后6个月血清NT-proBNP水平、左室舒张末期内径及左室射血分数的变化. 结果 术前两组血清NT-proBNP水平差异无统计学意义（P＞0.05）,术后6个月随访检测血清NT-proBNP水平,两组都有所增加,但右室心尖部起搏组较右心室间隔部组升高（P＜0.05）;右心室间隔部起搏组术后左室舒张末期内径和左室射血分数与术前比较差异无统计学意义（P＞0.05）;右室心尖部起搏组术后6个月左室舒张末期内径较术前增大,左室射血分数减小（P＜0.05）.直线相关性分析示NT-proBNP水平与左室射血分数呈负相关（γ=-0.76,P＜0.05）. 结论 与右室心尖部起搏相比,右室间隔部起搏能保证心室正常的激动顺序,且对左心收缩功能的不良影响小,是一种较为理想的起搏部位.

Objective To investigate the effects of different pacing sites of right ventricle on serum N terminal Pro brain natriuretic peptide （NT-ProBNP） and left ventricular systolic function.Methods A total of 76 patients with an implanted DDD pacemaker were randomly divided into right ventricular septal pacing group （RVSP group,n=40） and right ventricular apex pacing group （RVAP group,n=36） according to the ventricular leads position.Serum NT-proBNP level,left ventricular end diastolic dimension（LVEDD）and left ventricular ejection fraction（LVEF）were analyzed before and 6 months after operation in the two groups.Results There was no difference in serum NT-proBNP level between the two groups before operation,but the serum NT-proBNP level increased in both groups 6 months after operation,and it was higher in RVAP group than in RVSP group （P〈0.05）.There were no significant differences in LVEDD and LVEF in RVSP group before and after implantation （P〉0.05）.Compared with pre-implantation,LVEDD was increased and LVEF was decreased in RVAP group 6 months after implantation （both P〈0.05）.Linear correlation analysis showed that serum NT-proBNP level was negatively correlated to LVEF （2γ=-0.76,P〈0.05）.Conclusions Compared with RVAP,RVSP can keep the normal sequence of electrical activity and exert less adverse effects on left ventricular systolic function.Therefore,RVS is an ideal pacing location.