双腔起搏器植入对非吸烟缓慢性心律失常患者中心动脉压和动脉波增强指数的影响

Effects of dual-chamber pacemaker on central arterial pressure and augmentation index in non-smoking patients with bradyarrhythmia

目的探讨双腔起搏器对非吸烟缓慢性心律失常患者中心动脉压(CAP)和动脉波增强指数(AI)的影响。方法选取2016年6月至2018年4月枣庄市立医院诊治的61例缓慢性心律失常并植入起搏器的非吸烟患者为研究对象,将双腔起搏器患者纳入DDD组(21例),单腔起搏器患者纳入VVI组(28例),植入起搏器但术后心律为正常窦性心律患者纳入对照组(12例)。术后第7天,测量患者CAP、AI、收缩压(SBP)、舒张压(DBP)、心率(HR),将AI按75次/分的心率进行校正后得到AIc,程控DDD组患者起搏器由双腔起搏模式转变为单腔起搏模式,调整完成后5 min,重新测量以上各指标值。结果 3组患者HR、SBP、DBP、CAP、AI、AIc相比,差异有统计学意义(均P<0.05)。两两比较:DDD组和VVI组患者HR均低于对照组(均P<0.05),VVI组患者SBP、DBP、CAP均低于对照组(均P<0.05),DDD组患者CAP、AI、AIc均高于对照组(均P<0.05),DDD组患者SBP、DBP、CAP、AI、AIc均高于VVI组(均P<0.05)。DDD组患者程控后DBP、SBP、CAP、AI、AIc均较程控前降低,差异有统计学意义(均P<0.05)。程控前后HR相比,差异无统计学意义(P>0.05)。结论双腔起搏器可使非吸烟缓慢性心律失常患者CAP和AI提高,其机制有待进一步研究。

Objective To investigate the effects of dual-chamber pacemakers on central arterial pressure(CAP)and augmentation index(AI)in non-smoking patients with bradyarrhythmia.Methods Sixty-one non-smoking patients with bradyarrhythmia and pacemakers who were diagnosed and treated in Zaozhuang Municipal Hospital from June 2016 to April 2018 were enrolled in the study.The patients with dual-chamber pacemakers were included in DDD group(21 cases).Patients with single-chamber pacemakers were included in VVI group(28 cases).Patients with a pacemaker but a normal sinus rhythm after surgery were included in control group(12 cases).On the 7 th day after surgery,the patient’s CAP,AI,systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were measured,and AI was adjusted at a heart rate of 75 beats/min to obtain AIc.The pacemaker of the DDD group was changed from the dual-chamber pacing mode to the single-chamber pacing mode.Five minutes after the adjustment was completed,the above indicators were re-measured.Results There were significant differences in HR,SBP,DBP,CAP,AI and AIc among 3 groups(P<0.05).HR in DDD group and VVI group were lower than that in control group(both P<0.05).SBP,DBP and CAP in VVI group were lower than those in control group(all P<0.05).CAP,AI,and AIc in DDD group were higher than those in control group(all P<0.05).SBP,DBP,CAP,AI and AIc in DDD group were higher than those in VVI group(all P<0.05).After the adjustment of pacing mode,DBP,SBP,CAP,AI and AIc in DDD group all became lower,and the differences were statistically significant(all P<0.05).There was no significant difference in HR before and after the adjustment(P>0.05).Conclusion Dual-chamber pacemakers can significantly increase CAP and AI in non-smoking patients with bradyarrhythmia,and its specific mechanism needs further study.