不同起搏模式对起搏器植入患者长期生存预后的影响分析

Influence of different pacing modes on long-term survival prognosis in patients with pacemaker implantation

目的 本研究通过对植入永久心脏起搏器患者长期随访观察,评价双腔起搏（DDD）与单腔心室起搏（VVI）对起搏器植入患者长期生存情况的影响。方法 回顾性分析了1991年1月~2010年12月之间因心脏传导系统疾病而植入永久心脏起搏器的患者1245例,植入DDD起搏器915例（73.49%）,VVI起搏器330例（26.51%）。从起搏器植入后进行连续随访,收集患者起搏器植入后的随访数据直至观察终点。采用Kaplan-Meier方法评估患者生存率。采用log Rank检验评价不同起搏模式之间患者的生存差异,多因素Cox分析影响生存预后的危险因素。结果 1245例患者中,植入DDD起搏器患者存活846例,存活率92.5%,植入VVI起搏器存活291例,存活率88.2%,不同起搏模式对患者的生存预后无影响（χ2=3.248,P〉0.05）;植入时的年龄（RR=1.987,P〈0.001）,植入时合并缺血性心肌病（RR=8.418,P〈0.001）,合并扩张型心肌病（RR=45.332,P〈0.001）是影响患者生存率的主要因素。结论 植入永久心脏起搏器患者的长期生存率与植入起搏器的起搏模式无关,而植入时年龄、合并缺血性心肌病、合并扩张型心肌病是影响患者生存的主要因素。

Objective To review the influence of DDD pacing and VVI pacing on long-term survival status through long-term follow-up and observation in patients with implantation of permanent pacemaker. Methods The patients （n=1245） with implantations of permanent pacemakers due to disease of cardiac conduction system were retrospectively analyzed from Jan. 1991 to Dec. 2010, including 915 cases （73.49%） with DDD pacemakers and 330 （26.51%） with VVI pacemakers. All patients were followed up after pacemaker implantation, and follow-up data was collected after pacemaker implantation until the endpoint. The survival rate was reviewed by using Kaplan-Meier method, difference in survival status between different pacing modes was reviewed by using log Rank test, and risk factors affecting survival prognosis were analyzed by using multiple Cox regression analysis. Results In 1245 patients, there were 846 with DDD pacemakers survived and survival rate was 92.5%, and 291 with VVI pacemakers survived and survival rate was 88.2%. Different pacing modes had no influence on survival prognosis （χ2=3.248, P〉0.05）. Age （RR=1.987, P〈0.001）, ischemic cardiomyopathy （RR=8.418, P〈0.001） and dilated cardiomyopathy （RR=45.332, P〈0.001） during pacemaker implantation were main influencing factors on survival rate. Conclusion The long-term survival rate is not related to pacing modes in patients with implantations of permanent pacemakers, and age, ischemic cardiomyopathy and dilated cardiomyopathy are major influencing factors on survival status.