本文選題：心尖部起搏 + 間隔部起搏�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:人工心臟起搏治療是完全性房室傳導(dǎo)阻滯患者的常規(guī)治療手段,而右室心尖(RVA)是傳統(tǒng)的心室電極植入部位,但其可能損害心臟結(jié)和功能并增加術(shù)后房顫發(fā)生率。之前有多項(xiàng)對(duì)比RVA起搏與非RVA起搏的研究,但是得出了矛盾的結(jié)論,本研究意在對(duì)比非RVA起搏與RVA起搏對(duì)心臟結(jié)構(gòu)、功能的影響,探究右室間隔部(RVS)起搏在左室功能正常的完全性房室傳導(dǎo)阻滯患者中能否產(chǎn)生更大的益處。方法:本研究采用回顧性研究的方法。從2010年12月至2011年12月期間入住青大附院心內(nèi)科的患者中,隨機(jī)篩選60例主要診斷為完全性房室傳阻滯并行永久性心臟雙腔起搏器植入者,排除房顫、心衰、竇房結(jié)病變史、合并其他心房纖顫危險(xiǎn)因素疾病以及惡性腫瘤患者等,將入組患者分為兩組:RVA組為心尖部起搏患者組(n=30,女性14(46.7%)例),RVS組為間隔部起搏患者組(n=30,女性13(50%)例),統(tǒng)計(jì)并對(duì)比基線左室射血分?jǐn)?shù)(LVEF)、左房?jī)?nèi)徑(LAD)、左室舒張末期內(nèi)徑(LVEDd)、左室收縮末期內(nèi)徑(LVEDs),以及基礎(chǔ)疾病情況等資料,對(duì)比組間差異。于術(shù)后5年召回隨訪,隨訪內(nèi)容有:心臟結(jié)構(gòu)指標(biāo):左房?jī)?nèi)徑(LAD)、左室舒張末期內(nèi)徑(LVEDd)、左室收縮末期內(nèi)徑(LVEDs);左室功能指標(biāo):左室射血分?jǐn)?shù)(LVEF);起搏器程控結(jié)果:新發(fā)房顫病例數(shù),永久性房顫病例數(shù),心室起搏比例;因心衰入院病人數(shù)等。統(tǒng)計(jì)患者術(shù)后5年期間總心室起搏比例,術(shù)后5年LVEF、LAD、LVEDd、LVEDs等,進(jìn)行組間及組內(nèi)比較。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差((?)±s)方式表示,組間比較采用t檢驗(yàn);計(jì)數(shù)資料以百分?jǐn)?shù)方式表示,采用卡方檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)處理。以P0.05認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:術(shù)后5年,兩組患者的LAD、LVEDd、LVEDs值較術(shù)前有增大趨勢(shì),且均有統(tǒng)計(jì)學(xué)差異(RVA P0.05,RVS P0.05)。兩組之間LAD值增大無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。兩組LVEF值均出現(xiàn)具有統(tǒng)計(jì)學(xué)差異的下降(RVA P0.05,RVS P0.05),組間差異亦有統(tǒng)計(jì)學(xué)顯著性(P0.05),此外,RVA組患者更易出現(xiàn)因心衰住院(P0.05)。兩組患者在新發(fā)房顫方面差異無(wú)統(tǒng)計(jì)學(xué)顯著性。結(jié)論:對(duì)于左室功能正常的完全性房室傳導(dǎo)阻滯患者:1.右室心尖部起搏比右室間隔起搏可對(duì)左室結(jié)構(gòu)產(chǎn)生更多的傷害性影響,對(duì)左房結(jié)構(gòu)影響無(wú)差異;2.右室心尖部起搏比右室間隔起搏對(duì)左室功能可產(chǎn)生更多的傷害性影響;3.在右室起搏比例水平相當(dāng)?shù)臈l件下,右室間隔起搏與右室心尖部起搏起搏相比,不能降低房顫發(fā)生率。
[Abstract]:Objective: artificial cardiac pacing is a routine treatment for patients with complete atrioventricular block. RVA is the traditional site of ventricular electrode implantation, but it may damage cardiac node and function and increase the incidence of postoperative atrial fibrillation. There have been many previous studies comparing RVA pacing with non RVA pacing, but the contradictory conclusions are drawn. The purpose of this study is to compare the effects of non RVA pacing and RVA pacing on cardiac structure and function. To explore whether RVS pacing can produce greater benefits in patients with complete atrioventricular block with normal left ventricular function. Methods: retrospective study was used in this study. From December 2010 to December 2011, 60 patients who were mainly diagnosed as complete atrioventricular block and permanent double chamber pacemaker implantation were randomly selected to exclude the history of atrial fibrillation, heart failure and sinus node disease. Patients with other risk factors of atrial fibrillation and malignant tumors, Two groups of patients were divided into two groups: 1 / RVA group: apical pacing group (n = 30), female group (n = 1446.7) RVS group (n = 30), septal pacing group (n = 30) and female group (n = 1350). The baseline left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), and left ventricular end-diastolic diameter (LVEDD) were compared and statistically compared. Left ventricular end-systolic diameter (LVEDsN), and basic disease, etc., The differences between groups were compared. After 5 years of recall follow-up, the following items were followed up: cardiac structure index: left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular function index: left ventricular ejection fraction, left ventricular ejection fraction (LVEFN), pacemaker program control result: number of new atrial fibrillation cases, left ventricular function index: left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEF). Number of permanent atrial fibrillation cases, ventricular pacing ratio, number of patients admitted to hospital due to heart failure, etc. The ratio of total ventricular pacing in 5 years after operation and LVEF, LVED, LVED and LVEDs in 5 years after operation were calculated and compared between and within groups. The measurement data were expressed in the form of mean 鹵standard deviation) 鹵s. T test was used for the comparison between groups, and the counting data was expressed as percentage, and chi-square test was used for statistical processing. P0.05 thought the difference was statistically significant. Results: 5 years after operation, the LVEDDs of the two groups showed an increasing trend compared with those of the patients before operation, and there were significant differences in RVA P0.05 and RVS P0.05. There was no significant difference in LAD between the two groups (P 0.05). There was a statistically significant decrease in LVEF between the two groups. The difference between the two groups was also significant (P 0.05). In addition, the patients in RVA group were more likely to be hospitalized with heart failure (P 0.05). There was no significant difference in new atrial fibrillation between the two groups. Conclusion: in patients with complete atrioventricular block with normal left ventricular function, 1: 1. Right ventricular apical pacing had more noxious effects on left ventricular structure than right ventricular septal pacing, but there was no difference in left atrial structure between right ventricular apex pacing and right ventricular septal pacing. Right ventricular apex pacing has more noxious effects on left ventricular function than right ventricular septal pacing. At the same level of right ventricular pacing, right ventricular septal pacing can not reduce the incidence of atrial fibrillation compared with right ventricular apex pacing.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.7

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