Ⅲ度房室传导阻滞行DDD起搏后的心功能变化

Changes of Cardiac Function after DDD Pacing on Third Degree Atrioventricular Block

目的:了解Ⅲ度房室传导阻滞行DDD起搏后的心功能变化,为临床提供有效的心脏起搏方式。方法:136例Ⅲ度房室传导阻滞患者被分为VVI组66例和DDD组70例,两组置入的心脏起搏器分别为心室抑制型起搏(单腔起搏,VVI)和全自动双腔起搏(DDD)。两组在术前和术后1年时观察以下指标:左室收缩末径(LVDs)、左室舒张末径(LVDd)、左房内径(LAD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVS)、室壁增厚率(ΔT%)、左心室短轴缩短率(ΔD%),左室射血分数(LVEF)、心脏指数(CI)、体循环血管阻力(SVR)、BNP水平。结果:术后1年,VVI组LVDd、LAD均明显高于术前,差异均有统计学意义(t=5.199、4.748,P<0.05);术后1年,VVI组LAD显著高于DDD组,差异有统计学意义(t=3.640,P<0.05)。术后1年,两组BNP水平均比术前明显升高,差异均有统计学意义(t=13.273、26.711,P<0.05);VVI组术后LVEF、CI均比术前明显下降,差异均有统计学意义(t=7.881、6.218,P<0.05);术后1年,VVI组LVEF显著低于DDD组,BNP显著高于DDD组,差异均有统计学意义(t=5.905、11.853,P<0.05)。在随访期间,VVI组心房颤动发生率为37.88%(25/66),DDD组为8.57%(6/70),差异有统计学意义(字2=16.580,P<0.05);VVI组缺血性脑卒中发生率为4.55%(3/66),DDD组为2.86%(2/70),差异无统计学意义(字2=0.273,P>0.05)。结论:对于Ⅲ度房室传导阻滞患者,DDD起搏对心功能的影响更小,且术后心房颤动发生率更低,具有良好的临床应用价值。

Objective： To learn the changes of cardiac function after DDD pacing on third degree atrioventricular block, and to provide an effective way of cardiac pacing.Method： 136 cases with third degree atrioventrieular block were divided into VVI group of 66 cases and DDD group of 70 cases, implanted cardiac pacemaker of the two groups were respectively ventricular inhibited pacing（single chamber pacing, VVI） and automatic dual chamber pacing（DDD）.In preoperative and postoperative 1 year the following indicators of the two groups were observed ： left ventricular end systolic diameter （LVDS）, left ventricular end diastolic diameter （LVDD）, left atrial diameter （LAD）, left ventricular posterior wall thickness（LVPWT）, interventricular septal thickness（IVS）, ventricular wall thickening rate（A T%）and left ventricular short axis shortening（△ d%）, left ventricular ejection fraction （LVEF）, cardiac index （CI）, systemic vascular resistance（SVR）, brain natriuretic peptide （BNP） level.Result： 1 year after surgery, LVDd and LAD of VVI group were significantly higher than preoperative, the differences were statistically significant（t=5.199, 4.748, P〈0.05）.1 year after operation, LAD of VVI group was significantly higher than that of DDD group, the difference was statistically significant（t=3.640, P〈0.05）.1 year after operation , compared with preoperative, BNP level of two groups were increased significantly, the differences were statistically significant （t=13.273, 26.711, P〈0.05）.Compared with preoperative, LVEF and CI of VVI group were decreased significantly, the differences were statistically significant（t=7.881, 6.218, P〈0.05）.l year after surgery, LVEF of VVI group was significantly lower than that of DDD group, BNP of VVI group was significantly higher than that of DDD group, the differences were statistically significant（t=5.905, 11.853, P〈0.05）.During the follow-up period, atrial fibrillation incidence of VVI group was 37.88% （25/66）, atrial fibrillation incidence of DDD group was 8.57% （6/70）, the difference was statistically significant （X2=16.580, P〈0.05）.Isehemic stroke incidence of VVI group was 4.55%（3/66）, ischemic stroke incidence of DDD group was 2.86% （2/70）, the differences was not significant（x =0.273, P〉0.05）.Condusion： For patients with third degree atrioventricular block, the effect of DDD pacing on cardiac function is smaller, and the incidence of postoperative atrial fibrillation is lower, which has a good clinical value.