单腔和双腔起搏对中心动脉压和动脉波增强指数的不同影响及临床意义

The influence and clinical significance of single and dual-chamber pacing on central aortic pressure and augmentation index

目的探讨起搏器植入患者单腔和双腔起搏对中心动脉压(CAP)和动脉波增强指数(AI)的不同影响及临床意义。方法顺序入选103例植入起搏器患者,其中植入双腔起搏器患者42例为DDD组,单腔起搏器患者41例为VVI组,植入起搏器但患者心率为正常窦性心律者20例为对照组,分别测量三组患者的心率(HR)、CAP、AI、外周收缩压、外周舒张压等指标,随后将双腔起搏组的DDD模式程控成VVI模式,再次测量上述指标,记录并进行统计。结果 DDD组CAP明显高于对照组和VVI组[(149.67±19.62)mmHg vs(138.70±18.69)mmHg,(124.33±19.34)mmHg,P<0.05];DDD组AI、AI_C和外周血压均高于VVI组(P<0.05);程控后的CAP、AI、AI_C和外周动脉血压水平均低于程控前(P<0.05)。结论双腔起搏组的CAP、AI和外周动脉血压均高于单腔起搏组。而CAP和AI的升高可能是双腔起搏较单腔起搏并未改善远期预后的原因之一。

Objective To assess the different effect of single-chamber pacing on central aortic pressure（CAP） and augmentation index（AI） compared with dual-chamber pacing and investigate the probable clinical significance. Methods One hundred and three patients with pacemaker-implanted were consecutively enrolled in this study. The patients were divided into three groups： single-chamber pacemaker group （41 cases）, dual-chamber pacemaker group （42 cases） and control group （20 cases） whose pacemakers were not working when examined. Heart rate （HR）, CAP, AI and brachial blood pressure （BP） were measured in all individuals. And then we turned DDD pa- cing mode of patients in dual-chamber pacemaker group into VVI pacing mode and measured these indexes again. Results CAP in dual-chamber pacemaker group was higher than the control group and single-chamber pacemaker group[（149.67±19.62） mmHg vs （138.70±18.69） mmHg,（124.33±19.34） mmHg,P〈0.05]. AI, AIC and bra- chial BP in dual-chamber pacemaker group were higher than in single-chamber pacemaker gr0up（P d0.05）. All of these indexes except HR were lower significantly after we turned the pacing mode（P〈0.05）. Conclusion CAP, AI and brachial BP in dual-chamber pacing are all higher than single-ehamber pacing. The elevated CAP and AI may attribute to the indifferent adverse effects on cardiovascular events and long-term prognosis between dual-chamber pacing and single-chamber pacing.