合并高血压的老年缓慢型心律失常患者起搏器置入前后血压特点分析

Analysis of blood pressure characteristics before and after pacemaker implantation in elderly patients with hypertension associated with slow arrhythmia

目的:探讨合并高血压的病态窦房结综合征、高度房室传导阻滞的老年患者在未改变降压药物治疗的基础上,安置心脏永久起搏器后血压的变化特点。方法:回顾性分析北京安贞医院,2014年至2016年,因缓慢型心律失常行永久起搏器置入的患者,其中包括病态窦房结综合征(SSS)患者192例;Ⅲ度房室传导阻滞(Ⅲ°-AVB)患者155例;Ⅱ°Ⅱ型房室传导阻滞患者59例,记录临床资料,比较三组患者起搏器置入前后SBP、DBP、脉压特点以及变化。结果:(1)组内比较:SSS术前术后血压变化:[SBP(136.0±17.2)vs.(135.6±14.4)mmHg;DBP(71.7±11.3)vs.(71.1±7.7)mmHg;脉压(64.6±17.0)vs.(64.5±13.7)mmHg,P均>0.05)]。Ⅱ°-Ⅱ型AVB术前术后血压变化:[SBP(141.0±19.7)vs.(140.1±19.7)mmHg;DBP(69.8±10.5)vs.(73.0±8.0)mmHg;脉压(71.7±20.6)vs.(67.1±13.7)mmHg,P均>0.05]。Ⅲ°-AVB术前术后血压变化:[SBP(142.4±19.8)vs.(139.6±15.4)mmHg;DBP(69.4±11.3)vs.(71.9±8.3)mmHg,P均>0.05];脉压[(73.0±21.4)vs.(67.7±13.9)mmHg,P<0.05],差异有统计学意义。(2)组间比较:SSS与Ⅲ°-AVB术前SBP、脉压,术后DBP、脉压相比,差异有统计意义(P均<0.05),其余两组间血压比较可见有一定差异,但差异无统计学意义。结论:虽然起搏器置入术对SSS、Ⅱ°-Ⅱ型AVB患者的血压有一定影响,并可见变化趋势;而起搏器置入术对Ⅲ°AVB患者的脉压有明显影响,且对脉压的影响可能通过降低SBP和升高DBP两方面起作用。因此,Ⅲ°AVB患者术前DBP低而SBP过高可能是一种代偿机制,可不予积极降压,以免DBP进一步下降而增加脑卒中风险,而起搏器置入术可能有降低其SBP的作用,故术后应密切监测患者血压,并适当予降压药物调整。

Objective： To investigate the blood pressure changes in sinoatrial node syndrome as well as high degree atrioventricular block of elderly patients who also have the disease of hypertension on condition that they are not have changed antihypertensive drugs in hospital. Methods： This is a retrospective study,analysis is collected from Beijing An Zhen Hospital during 2014 to 2016,patients are selected on the condition that having slow arrhythmia,further more,having permanent pacemaker implantation,including sick sinus syndrome（ SSS）patients in 192 cases; 155 cases with three degree atrioventricular block（ AVB） patients; 59 cases of Mobitz ⅡAVB,collected their clinical characteristics. Then,compare blood pressure include systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and pulse pressure difference of three groups before and after pacemaker implantation. Results： Intragroup Comparison：（ preoperative to postoperative changes） SSS： SBP（ 136. 0 ±17. 2） vs.（ 135. 6 ± 14. 4） mmH g; DBP（ 71. 7 ± 11. 3） vs.（ 71. 1 ± 7. 7） mmH g; pulse pressure（ 64. 6 ± 17. 0）vs.（ 64. 5 ± 13. 7） mmH g; P〈0. 05（ all of the blood pressure change） Mobitz ⅡAVB： SBP（ 141. 0 ± 19. 7） vs.（ 140. 1 ± 19. 7） mmH g; DBP（ 69. 8 ± 10. 5） vs.（ 73. 0 ± 8. 0） mmH g; pulse pressure（ 71. 7 ± 20. 6） vs.（ 67. 1± 13. 7） mmH g（ P〈0. 05）. Third-degree AVB： SBP（ 142. 4 ± 19. 8） vs.（ 139. 6 ± 15. 4） mmH g（ P〈0. 05）;DBP（ 69. 4 ± 11. 3） vs.（ 71. 9 ± 8. 3） mmH g（ P〈0. 05）; Pulse pressure（ 73. 0 ± 21. 4） vs.（ 67. 7 ± 13. 9）mmH g（ P〈0. 05）. Comparison Between The Groups： There were significantly different between SSS and Thirddegree AVB in SBP、pulse pressure before operation as well as DBP、pulse pressure after operation（ P〈0. 05）.Although there were some differences in blood pressure between the other two groups,the difference was not statistically significant. Conclusion： After intra-group and comparison between groups,the result show that although pacemaker implantation had some effect on blood pressure in patients of SSS as well as Mobitz ⅡAVB,but there was no statistical significance; however pacemaker implantation had a significant effect on pulse pressure of patients with third-degree AVB,reduction of pulse pressure difference may through reducing systolic blood pressure as well as increasing diastolic pressure. Therefore,it may be a compensatory mechanism of third-degree AVB with low DBP but high SBP. So,to avoid further decline in DBP,we can consider not lower their blood pressure actively,in case of increasing their risk of stroking. Pacemaker implantation may reduce systolic blood pressure,so the blood pressure should be monitored closely after operation and adjusted with antihypertensive drugs.