影响起搏器植入患者生存率的预后因素

Factors influencing prognosis of survival rate of patients with pacemakers

目的通过连续随访起搏器植入患者,观察长期右室起搏的患者生存情况及可能影响预后的危险因素。方法自1991年1月-2010年12月，因II度II型房室传导阻滞、III度房室阻滞、心房纤颤伴长间隙以及病态窦房结综合征等症状性缓慢心律失常植入永久起搏器的患者1 245例，自植入起搏器后进行连续随访，收集患者起搏器植入时的一般信息特征及伴随的疾病。采用Kaplan-Meier方法评估患者生存率。采用log Rank检验评价，单因素分析影响起搏器植入患者预后的危险因子，Cox多因素分析评估影响生存预后的独立危险因素。结果在3-23年的随访中，总的生存率为91.3%；5年生存率、10年生存率、15年生存率、〉20年生存率分别为92.9%，88.7%，81.9%和75.1%；单因素分析影响起搏器患者生存预后的危险因子有：年龄、性别、起搏模式、慢性肾功能衰竭、缺血性心肌病、扩张型心肌病；Cox多因素分析，影响起搏器植入患者生存预后的独立危险因素是：年龄、缺血性心肌病、扩张型心肌病。结论植入永久心脏起搏器患者的寿命显著延长，影响起搏器植入患者生存预后的独立危险因素是：起搏器植入时的年龄、缺血性心肌病和扩张型心肌病。

AIM To observe the long-term survival of patients with right ventricular pacing and to explore the risk factors that may affect the prognosis. METHODS A retrospective follow-up analysis was con- ducted in 1,245 patients implanted with permanent pacemaker from January 1991 to December 2010 for type II, degree II atrial-ventricular block, III degree atrial-ventricular block and auricular fibrillation with long interval and sick sinus syndrome such as slow cardiac arrhythmia. Follow-up data were continuously collected after pacemaker implantation until the endpoint. Survival rate was estimated using the Kaplan- Meier method and risk factors for mortality were sought using the multivariate Cox proportional hazards method. RESULTS The total survival rate during follow-up （3 -23 years） was 91.3% and the survival rates at 5, 10, 15 and 20 years were, respectively, 92. 9% , 88.9% , 81.9% and 75. 1%. Single factor analysis showed that age, gender, pacemaker mode, chronic renal failure, ischemic cardiomyopathy and dilated cardiomyopathy （DCM） were the risk factors affecting the survival. Independent predictors of increased mortality were age at implant （hazard ratio, HR 1. 987; 95% confidence interval, CI 1. 587 - 2. 489）, DCM （ HR 45.332; 95% CI 24. 321 - 84. 495 ） and ischemic cardiomyopathy （ HR 8.418 ;95% CI 3.605 - 19.65 ）. CONCLUSION Implantation of permanent pacemaker prolongs the life of patients. Age at implant, ischemic cardiomyopathy and DCM are the independent risk factors for inereasedmortality.