高位右室间隔部起搏与右室心尖部起搏对患者心功能的影响

Influence of High Right Ventricular Septal Pacing and Right Ventricular Apical Pacing on Cardiac Function

目的:探讨右室心尖部(RVA)起搏与高位右室间隔部(HRVS)起搏对患者心脏功能、左室重构及心室同步性的影响。方法:选取本院2008年1月-2012年12月因Ⅲ度房室传导阻滞(ⅢAVB)或病态窦房结综合征(SSS)植入VVI型起搏器的患者126例作为研究对象,其中61例为RVA起搏,65例为HRVS起搏。观察比较两组术前及术后6个月、1年的左室射血分数(LVEF)、左室舒张末内径(LVEDD)、QRS波群宽度、纽约心脏病学会(NYHA)心功能分级及术后因NYHA心功能Ⅲ/Ⅳ级或心力衰竭住院患者数。结果:两组术前各项指标比较差异无统计学意义(P>0.05),术后6个月及1年,HRVS组LVEF高于RVA组,LVEDD及QRS波宽度均低于RVA组,比较差异均有统计学意义(P<0.05);术后1年,HRVS组NYHA心功能Ⅲ/Ⅳ级及因心力衰竭住院患者数低于RVA组,比较差异均有统计学意义(P<0.05)。结论:HRVS起搏对心脏起搏治疗患者心功能的不利影响低于RVA起搏,是更理想的起搏部位。

Objective： To explore the influence of high right ventricular septal （ HRVS ） pacing and right ventricular apical （ RVA ） pacing on patients＇ cardiac function, left ventricular remodeling and ventricular synchrony.Method： 126 patients who implanted VVI pacemaker because of II1 degree atrioventrieular block （ Ⅱ AVB ） or sick sinus syndrome （ SSS ） in our hospital from January 2008 to December 2012 were selected as the research objects.Among them, there were 61 eases with RVA pacing and 65 eases with HRVS.The left ventricular ejection fraction （ LVEF ）, left Ventrieular end-diastolic diameter （ LVEDD ）, QRS wave group width and New York Heart Association （ NYHA ） functional classification of the two groups were observed and compared before operation and six months, 1 year after operation.The number of hospitalizations for heart failure after operation was compared between the two groups.Result： Before treatment, the differences in the indexes of the two groups were not statistically significant （ P〉0.05 ） .Six months and one year after surgery, the LVEF of the HRVS group was higher than that of the RVA group, the LVEDD and QRS wave width of the HRVS group were lower than those of the RVA group, the differences above were all statistically significant （ P〈0.05 ） .One year after surgery, the number of cardiac function Ⅲ or IV level and the number of hospitalizations for heart failure of the HRVS group were lower than those of the RVA group, the differences were statistically significant （ P〈0.05 ） .Conclusion： HRVS pacing is a more desirable pacing site because of its less adverse effects on cardiac function compared with RVA pacing.