永久性心脏起搏器置入术后起搏阈值升高患者的临床特点及其相关影响因素分析

Analysis on clinical characteristics of elevated threshold of pacing in patients with permanent pacemaker and related influencing factors

目的观察永久性心脏起搏器置入术后起搏阈值升高患者的临床特点,并分析其相关影响因素。方法回顾性分析2014年9月至2016年9月石家庄市第一医院心血管内科收治的185例置入永久性心脏起搏器患者的临床资料,根据患者术后10 min是否存在起搏阈值升高将其分为两组:起搏阈值升高者纳入A组(n=48),起搏阈值正常者纳入B组(n=137)。对比研究两组患者的临床资料,分析起搏阈值升高的相关危险因素,比较A组术后24 h、48 h、72 h的心肌损伤标记物血清肌红蛋白(MYO)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(c TNI)水平。结果两组患者的年龄、性别、高血压、甲状腺功能亢进症/减退症、慢性阻塞性肺疾病的差异均无统计学意义(P>0.05);A组患者的冠心病、糖代谢异常、高脂血症、吸烟、饮酒的发生率均明显高于高于B组,差异有统计学意义(P<0.05);经Logistic回归分析,提示冠心病、糖代谢异常、高脂血症、吸烟、饮酒均为起搏阈值升高的相关性因素(P<0.05);A组术后24 h、48 h的心肌损伤标记物MYO、CK、CK-MB、LDH、c TNI均较术前明显升高,差异有统计学意义(P<0.05),但术后72 h上述指标与术前比较,差异均无统计学意义(P>0.05)。结论冠心病、糖代谢异常、高脂血症及有吸烟史、饮酒史患者置入永久性心脏起搏器后,术后短期起搏阈值升高的风险较高;主动电极对心肌的损伤可能是术后短期起搏阈值升高的重要原因,但均能于术后72 h恢复至正常范围,其安全性有保障。

Objective To observe the clinical characteristics of patients after implantation of permanent pacemaker,and to analyze its related influencing factors. Methods A retrospective analysis on the clinical data of 185 cases in cardiovascular department of this hospital during September 2014 to September 2016 had been carried out in permanent pacemaker patients,they were divided into 2 groups according to the existence of pacing threshold at 10 min after the operation,： patients with elevated pacing threshold were included in group A（ n = 48）,and patients with normal pacing threshold were listed in group B（ n = 137）. The clinical data of these two groups of patients,the risk factors for damage in elevated pacing threshold,myocardial markers of serum myoglobin（ MYO） in 24 h,48 h,and 72 h,creatine kinase（ CK）,creatine kinase isoenzyme（ CK-MB）,lactate dehydrogenase（ LDH） and troponin I（ cT NI level） were compared between these groups of patients. Results The difference in age,sex,hypertension,hyperthyroidism or hypothyroidism and difference in chronic obstructive pulmonary disease between these2 groups were not statistically significant（ P〈0. 05）. Rates of coronary heart disease and abnormal glucose metabolism,hyperlipidemia,smoking and drinking in patients of group A were significantly higher than those of patients in group B,and the difference was statistically significant（ P〈0. 05）. Logistic regression analysis showed that coronary heart disease,abnormal glucose metabolism,hyperlipidemia,smoking and drinking were related factors for elevated pacing threshold（ P〈0. 05）. MYO,CK,myocardial injury markers CK-MB,LDH and cT NI in patients of group A after implantation for 24 and 48 h were significant increased,and the difference was statistically significant（ P〈0. 05）,but these indices in 72 h after implantation compared with those before operation,the difference was not significant（ P〈0. 05）. Conclusion The risk of short-term elevation of pacing threshold in patients with coronary heart disease having abnormal glucose metabolism,hyperlipisemia,smoking history was higher after implantation of permanent cardiac pacemaker. The injury of active electrode to myocardium may be an important factor for the increase of postoperative short-term threshold of pacemaker,but it can be restored to normal range in 72 h after operation,and its safety is guaranteed.