右室不同间隔部位起搏对心功能的影响研究

Effects of Right Ventricular Septum Pacing on Cardiac Function

目的:研究对比右室中位间隔部起搏与右室高位间隔部起搏对心功能的影响。方法:于2018年1月至2020年3月,将我院100例进行心脏永久性起搏器植入术的完全房室传导阻滞患者纳入研究,按照1∶1的分配比例,将患者完全随机分配到两个组别,每组50例。A组于右室高位间隔部起搏,B组于右室中位间隔部起搏,比较两组的N末端脑钠肽水平(NT-proBNP)、心脏彩超监测指标、QRS波时限、生命质量评分、心脏不良事件发生率。结果:两组术后3个月、6个月的NT-proBNP水平均较术前显著降低(P<0.05),而术后3个月、6个月时B组的NT-proBNP水平均低于A组(P<0.05)。两组术后3个月、6个月的LVEF、LVEDD、LVESD、LAEF均较术前显著改善(P<0.05),而术后3个月、6个月时,B组的LVEF、LAEF均高于A组(P<0.05),B组的LVEDD、LVESD均低于对照组(P<0.05)。两组术后3个月、6个月的QRS波时限均较术前显著缩短(P<0.05),而术后3个月、6个月时B组的QRS波时限短于A组(P<0.05)。两组术后3个月、6个月的生命质量评分均较术前显著降低(P<0.05),而术后3个月、6个月时B组的生活质量评分均低于A组(P<0.05)。术后6个月内,A组心脏不良事件发生率为8.00%,B组4.00%,组间比较无显著差异(P>0.05)。结论:在右室中位间隔部起搏对心脏永久性起搏器植入术患者可起到改善心功能的作用,其对心功能的改善作用优于右室高位间隔部起搏,且心脏不良事件风险未增高,安全性可靠。

Objective:To study and compare the effects of right ventricular middle septum pacing and right ventricular high septum pacing on cardiac function.Methods:From January 2018 to March 2020,100 patients with complete atrioventricular block undergoing permanent pacemaker implantation in our hospital were included in the study,and were divided into 2 groups with 50 patients in each according to the random number table method.Group A was pacing at the high septum of right ventricle,while group B was pacing at the middle septum of right ventricle.The levels of n-terminal brain natriuretic peptide(NT-proBNP),cardiac color Doppler monitoring index,QRS wave time limit,quality of life score and incidence of adverse cardiac events were compared between the two groups.Results:The levels of NT-proBNP in both groups were significantly lower than those before operation at 3 and 6 months after operation(P<0.05),while the levels of NT-proBNP in Group B were lower than those in Group A at 3 and 6 months after operation(P<0.05).The LVEF,LVEDD,LVESD and LAEF at 3 and 6 months after operation were significantly improved in both groups(P<0.05),while the LVEF and LAEF in group B were higher than those in group a(P<0.05),while the LVEDD and LVESD in group B were lower than those in control group(P<0.05).The QRS wave duration of the two groups at 3 months and 6 months after operation was significantly shorter than that before operation(P<0.05),while the QRS wave duration of Group B was shorter than that of Group A at 3 months and 6 months after operation(P<0.05).The quality of life scores of both groups at 3 and 6 months after operation were significantly lower than those before operation(P<0.05),while the quality of life scores of Group B were lower than those of Group A at 3 and 6 months after operation(P<0.05).Within 6 months after operation,the incidence of adverse cardiac events in group A was 8.00%,while that in group B was 4.00%.There was no significant difference between the two groups(P>0.05).Conclusion:Pacing in the middle septum of right ventricle can improve the cardiac function of patients with permanent pacemaker implantation,which is better than pacing in the high septum of right ventricle,and the risk of adverse cardiac events is not increased,which verifies it’s safety and reliability.