不同起搏器植入部位对房室传导阻滞患者情绪状态的影响

Effect of Different Right Ventricular Pacing Sites on Emotional State in Patients with Atrioventricular Block after Implantation of Permanent Cardiac Pacemaker

目的观察不同起搏器植入部位对房室传导阻滞患者焦虑、抑郁情绪的影响,以期引起医生在治疗躯体疾病的同时,重视患者情绪状态的变化。方法根据纳入与排除标准,选取2012年12月—2014年12月河北医科大学第一医院心内科因高度或完全房室传导阻滞植入DDD型号或DDDR型号起搏器的患者78例为研究对象。采用随机数字表法将患者分为右心室心尖部(RVA)组(38例)和右心室流出道间隔部(RVOTs)组(40例)。收集患者一般资料,记录患者术前及术后4周QRS波群时限,术前、术后1周、术后4周焦虑自评量表(SAS)、抑郁自评量表(SDS)评分。结果 RVA组术后4周QRS波群时限长于RVOTs组(P<0.05)。两组术后4周QRS波群时限均长于术前(P<0.05)。起搏器植入部位与时间在SAS、SDS评分上不存在交互作用(P>0.05);起搏器植入部位在SAS、SDS评分上主效应不显著(P>0.05);时间在SAS、SDS评分上主效应显著(P<0.05);两组术后4周SAS、SDS评分均低于术前、术后1周(P<0.05)。结论 RVA起搏及RVOTs起搏均可减少患者的焦虑、抑郁症状,且两者间无差别。

Objective To investigate the effect of different right ventricular pacing sites on anxiety and depression in patients with atrioventricular block after implantation of permanent cardiac pacemaker,so as to emphasize the importance of psychological status in such patients with physical diseases.Methods The participants enrolled in this study were 78 cases with high degree or complete atrioventricular block,who were admitted in Department of Cardiology of the First Hospital of Hebei Medical University,and treated by implantation of DDD/DDDR pacemakers from December 2012 to December 2014.They were divided into right ventricular apex（RVA） group（n=38） and right ventricular outflow tract septum（RVOTs） group（n=40） by random number table method.Baseline characteristics of them were collected.QRS duration before surgery and at the 4th week after surgery,Self-Rating Anxiety Scale（SAS）and Self-Rating Depression Scale（SDS） scores before surgery,at the 1st and the 4th weeks after surgery were recorded.Results QRS duration in RVA group was longer than that in RVOTs group at the 4th week after surgery（P〈0.05）.QRS durations at the 4th week after surgery of both groups were longer than those before surgery（P〈0.05）.Pacing sties and implantation duration of the artificial cardiac pacemaker did not exert interaction effect on the SAS and SDS scores（P〉0.05）.Implantation duration of the artificial cardiac pacemaker had significant major effect on SAS and SDS scores in both groups（P〈0.05）,while pacing sites did not（P〉0.05）.The SAS and SDS scores at the 4th week after surgery were lower than those before surgery and at the 1st week after surgery in both groups（P〈0.05）.Conclusion RVA pacing and RVOTs pacing both can reduce the symptoms of anxiety and depression,and there is no difference between them.