本文選題：美托洛爾 + 起搏器�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景三度房室傳導(dǎo)阻滯患者,心室對起搏器完全依賴,長期高比例的右心室起搏,導(dǎo)致心室不同步,類似于左束支傳導(dǎo)阻滯,對心臟結(jié)構(gòu)和功能產(chǎn)生不利影響,惡化患者的心功能,增加心房顫動、心力衰竭發(fā)生率,甚至增加死亡率。右室心尖部起搏作為心室經(jīng)典的起搏部位,在過去20年里,長期右室心尖部起搏相關(guān)的負(fù)面報道逐漸引起重視。對此,專家學(xué)者們提出改變心室電極植入位置避免長期高比例心室起搏對心功能的影響,如右室間隔部及希氏束起搏等。然而,右室心尖部因植入經(jīng)驗豐富、操作簡單、易于固定等優(yōu)點,沿襲數(shù)十年至今依然作為常規(guī)的心室起搏部位。因此,右室心尖部起搏在臨床上仍占據(jù)一定的比例,但長期高比例右室心尖部起搏對于心功能的影響需格外關(guān)注。目前關(guān)于藥物能否改善長期高比例右室心尖部起搏患者預(yù)后的研究甚少。美托洛爾是選擇性β1受體阻滯劑,通過抑制腎素-血管緊張素-醛固酮系統(tǒng)(RASS),延緩心肌重構(gòu),改善心功能,降低心臟不良事件的發(fā)生率。目的研究美托洛爾對DDD型起搏器治療三度房室傳導(dǎo)阻滯患者心功能、房顫負(fù)荷及QT間期離散度的影響。方法1.對象及分組連續(xù)納入2013年9月至2016年3月我院心內(nèi)科收治的三度房室傳導(dǎo)阻滯擇期行永久雙腔起搏器植入術(shù)的患者127例。根據(jù)起搏器術(shù)后1周是否應(yīng)用美托洛爾分為觀察組與對照組,其中應(yīng)用美托洛爾即觀察組53例,對照組74例。2.一般臨床資料兩組患者的年齡、性別、合并癥、藥物使用等一般情況,以及起搏器術(shù)后1周左房內(nèi)徑、左室舒張末內(nèi)徑、左室射血分?jǐn)?shù)、心率、QT間期離散度、血BNP等,將起搏器術(shù)后1周的輔助檢查指標(biāo)作為基線參考數(shù)據(jù)。3.隨訪及療效評價每位患者至少隨訪1年,采集程控數(shù)據(jù)信息,心臟彩超參數(shù),QT間期離散度及BNP等。4.統(tǒng)計分析應(yīng)用SPSS 20.0統(tǒng)計分析軟件,計量資料比較采用t檢驗,兩獨立樣本方差齊性檢驗采用Levene's test;計數(shù)資料采用χ2檢驗;p0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1.一般臨床資料比較對照組患者血脂異常較觀察組患者檢出率高(55.4%vs 35.8%,p0.05),余基線指標(biāo)無統(tǒng)計學(xué)差異。2.術(shù)后6個月觀察組及對照組兩組分別與同組基線比較,房顫負(fù)荷均增加(p0.05)。對照組心室率增加,而觀察組患者心率降低(p0.05).3.術(shù)后1年(1)與同組基線組比較,觀察組患者左室舒張末容積(LVEDD)、房顫負(fù)荷增加,心室率降低(P均0.05);對照組患者與同組基線組比較,左房內(nèi)徑(LAD)、左室舒張末內(nèi)徑(LVEDD)、BNP、房顫負(fù)荷、心室率、QTd增加(P均0.05)。(2)兩組左室射血分?jǐn)?shù)(LVEF)與同組基線比較差異均無統(tǒng)計學(xué)意義(P均0.05)。(3)對照組△左房內(nèi)徑(LAD)、△左室舒張末內(nèi)徑(LVEDD)、△房顫負(fù)荷(AFB)、△心室率(HR)及△ QT間期離散度變化量較觀察組明顯(P均0.05)。(4)兩組射血分?jǐn)?shù)變化量無統(tǒng)計學(xué)差異(P0.05)。4.兩組患者不良事件發(fā)生率比較觀察組患者室速發(fā)生率較對照組低,差異有統(tǒng)計學(xué)意義(p0.05)。兩組患者低血壓及呼吸困難的發(fā)生率無統(tǒng)計學(xué)差異(p0.05)。結(jié)論本研究我們得出以下幾點結(jié)論:1.長期高比例(至少持續(xù)1年)右心室心尖部起搏會使患者左房左室擴張、房顫負(fù)荷及QT間期離散度增加。2.應(yīng)用美托洛爾可改善患者一般臨床狀況,改善長期高比例右心室心尖部起搏患者的左房室擴張,降低房顫負(fù)荷及QT間期離散度等。3.兩組患者左室射血分?jǐn)?shù)無差異,可能與起搏器治療周期短,尚未對射血分?jǐn)?shù)造成明顯影響有關(guān)。4.美托洛爾改善長期高比例右室心尖部起搏患者的遠(yuǎn)期預(yù)后,并且不增加不良事件發(fā)生率。
[Abstract]:Background three patients with atrioventricular block, ventricles are completely dependent on pacemakers, long and high proportions of right ventricular pacing, leading to ventricular asynchrony, similar to left bundle branch block, adverse cardiac structure and function, worsening cardiac function, increased atrial fibrillation, heart failure rate, and even increase death rate. Right ventricle Apical pacing, as the classical pacing site of the ventricle, has been paid more and more attention in the past 20 years. For this reason, experts and scholars have proposed to change the position of ventricular electrode implantation to avoid the effect of long-term high proportion of ventricular pacing on cardiac function, such as the right ventricular septum and hash pacing. The apex of the ventricular apex has the advantages of rich experience, simple operation and easy fixation. It is still used as a conventional ventricular pacing site for decades. Therefore, right ventricular apex pacing still occupies a certain proportion in clinical, but the long-term high proportion of right ventricular apex pacing should be paid more attention to the effect of cardiac function. To improve the prognosis of patients with long-term and high proportion right ventricular apex pacing, metoprolol is a selective beta 1 receptor blocker, by inhibiting the renin angiotensin aldosterone system (RASS), delaying cardiac remodeling, improving cardiac function and reducing the incidence of adverse cardiac events. Objective to study the treatment of three degrees by metoprolol in the treatment of DDD pacemaker. The effects of ventricular conduction block on cardiac function, atrial fibrillation load and QT interval dispersion. Methods 1. subjects and groups were consecutively included in 127 cases of three degrees atrioventricular block in Department of Cardiology of our hospital from September 2013 to March 2016 with permanent double chamber pacemaker implantation. The application of metoprolol was observed at 1 weeks after the pacemaker operation. The group and the control group were treated with metoprolol, 53 cases of the observation group, 74 cases of.2. general clinical data in the control group, the age, sex, complication and drug use, as well as the left atrial diameter, the left ventricular end diastolic diameter, the left ventricular ejection fraction, the heart rate, the QT interval dispersion, the blood BNP, and the 1 weeks after the pacemaker operation. As baseline reference data.3. follow-up and therapeutic evaluation, each patient was followed up for at least 1 years. The data of program controlled data, cardiac color Doppler parameters, QT interval dispersion and BNP and other.4. statistical analysis were applied to SPSS 20 statistical analysis software. The measurement data were compared with t test, and Levene's test was used in two independent sample variance homogeneity test. The count data were tested with chi 2 test, and P0.05 was statistically significant. Results 1. general clinical data compared with the control group, the blood lipid abnormality was higher than that in the observation group (55.4%vs 35.8%, P0.05), and there was no statistical difference in the residual baseline index. The 6 months after.2. operation and the control group two groups were compared with the same group baseline, the atrial fibrillation load increased (P 0.05) the ventricular rate in the control group was increased, while the rate of heart rate decreased (P0.05) in the observation group was 1 years after.3. (1), compared with the same group, the left ventricular end diastolic volume (LVEDD), the atrial fibrillation load increased and the ventricular rate decreased (P 0.05) in the observation group. Compared with the same group, the left atrial diameter (LAD), the left ventricular end diastolic diameter (LVEDD), BNP, and atrial fibrillation were negative in the control group. Charge, ventricular rate and QTd increased (P 0.05). (2) there was no significant difference between the two groups of left ventricular ejection fraction (LVEF) and the same group (P 0.05). (3) Delta left atrium diameter (LAD), delta left ventricular end diastolic diameter (LVEDD), delta atrial fibrillation load (AFB), delta ventricular rate (HR) and delta dispersion (P 0.05). (4) two groups (4) two groups There was no statistical difference in the change of ejection fraction (P0.05) the incidence of adverse events in group.4. two patients was lower than that in the control group, the difference was statistically significant (P0.05). There was no statistical difference between the two groups of patients with hypotension and dyspnea (P0.05). Conclusion we concluded the following conclusions in this study: 1. long term high The ratio (at least 1 years) of the right ventricular apex pacing will make the left ventricular left ventricle dilated, atrial fibrillation load and QT interval dispersion increase by.2. application metoprolol can improve the general clinical status of patients, improve the left atrioventricular dilatation, lower atrial fibrillation load and QT interval dispersion in the long term high proportion of right ventricular apex pacing patients, and improve the patient's left atrioventricular dilatation, lower atrial fibrillation load and QT interval dispersion. There is no difference in left ventricular ejection fraction, which may be short of the pacemaker period, and has not significantly affected the ejection fraction of.4. metoprolol to improve the long-term prognosis of the long-term and high proportion of right ventricular apical pacing patients, and does not increase the incidence of adverse events.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.7

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