【摘要】：目的:評價不同的心臟起搏模式(VVI與DDD)對高齡起搏器植入患者預后的影響。方法:入選我院(馬鞍山市人民醫(yī)院)60例因心臟傳導系統(tǒng)疾病(房室傳導阻滯、心房顫動伴房室傳導阻滯或長間歇、病態(tài)竇房結綜合征等緩慢性心律失常)植入永久心臟起搏器的高齡患者,按照植入起搏器的類型,分為雙腔起搏器(DDD)組27例和單腔起搏器(VVI)組33例。采用多普勒心臟彩超、N末端腦鈉肽原(NT-pro BNP)和SF-36生活質(zhì)量調(diào)查表為觀察手段,評估兩組患者術前、術后一年的左房舒張末期內(nèi)徑(LAEDD)、左室舒張末期內(nèi)徑(LVEDD)和左室收縮末期內(nèi)徑(LVESD)3個心臟內(nèi)徑指標、左室射血分數(shù)(LVEF)、N末端腦鈉肽原(NT-pro BNP)以及SF-36生活質(zhì)量調(diào)查表的評分條目,通過上訴起搏器植入前后的指標比較兩組患者心功能和生活質(zhì)量的變化。結果:1 VVI與DDD兩組相比,術后半年、術后一年的心臟內(nèi)徑(LAEDD、LVEDD、LVESD)的變化1.1術后半年[LAEDD(40.52±7.57 VS 39.59±4.80,P0.05),LVEDD(50.9±5.53 VS 52.30±5.68,P0.05),LVESD(38.06±3.70 VS39.44±6.76,P0.05)]1.2術后一年[LAEDD(42.00±6.77 VS 41.15±6.05,P0.05),LVEDD(50.39±5.77 VS 53.74±8.66,P0.05),LVESD(38.64±5.52 VS41.41±9.22,P0.05)]2 VVI與DDD兩組相比,術后半年、術后一年的心功能(LVEF、NTpro-BNP)的變化2.1術后半年[LVEF(53.73±5.33 VS 51.81±9.38,P0.05),NTpro-BNP(235.73±112.20 VS 228.63±107.74,P0.05)]2.2術后一年[LVEF(53.45±6.74 VS 50.37±9.37,P0.05),NTpro-BNP(257.82±165.28 VS 248.33±136.74,P0.05)]3 VVI和DDD兩組相比,生活質(zhì)量[SF-36(總體健康)]的變化3.1術后半年[總體健康(78.33±9.63 VS 79.22±10.29,P0.05)]3.2術后一年[總體健康(85.97±6.92 VS 86.15±7.75,P0.05)]結論:1、單腔起搏器和雙腔起搏器植入后對高齡患者心臟內(nèi)徑的變化無明顯影響。2、單腔起搏器和雙腔起搏器植入后高齡患者心臟射血分數(shù)下降、NTpro-BNP升高均不明顯,心臟收縮功能無明顯減低。3、單腔起搏器和雙腔起搏器植入后都能明顯改善高齡患者的癥狀,提高患者的生活質(zhì)量,但是兩者對比無明顯差異。
[Abstract]:Objective: to evaluate the effect of different pacing modes (VVI and DDD) on the prognosis of elderly patients with pacemaker implantation. Methods: sixty patients with heart conduction system diseases (atrioventricular block, atrial fibrillation with atrioventricular block or long interval) were enrolled in our hospital (Ma'anshan people's Hospital). According to the type of pacemaker implanted, the elderly patients were divided into two groups: double chamber pacemaker (DDD) group (n = 27) and single chamber pacemaker (VVI) group (n = 33). Doppler echocardiography, N-terminal brain natriuretic peptide (NT-pro BNP) and SF-36 quality of life questionnaire were used to evaluate left atrial end-diastolic diameter (LAEDD),) before and one year after operation. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), N) end brain natriuretic peptide (NT-pro BNP), and SF-36 quality of life (QOL) were measured. The changes of cardiac function and quality of life were compared between the two groups before and after pacemaker implantation. Results: 1Compared with DDD group, the changes of cardiac diameter (LAEDD,LVEDD,LVESD) half a year after operation in VVI group and DDD group [LAEDD (40.52 鹵7.57 VS, 39.59 鹵4.80 VS, P 0.05, 50.9 鹵5.53 VS, 52.30 鹵5.68), respectively] half a year after operation [LAEDD (40.52 鹵7.57 VS, 39.59 鹵4.80)]; P05), LVESD (38.06 鹵3.70 VS39.44 鹵6.76 VS39.44] 1.2 one year after operation [LAEDD (42.00 鹵6.77 VS, 41.15 鹵6.05 VS, P0.05), LVEDD (50.39 鹵5.77 VS 53.74 鹵8.66, P0.05)], LVESD (38.64 鹵5.52 VS41.41 鹵9.22 VS41.41)] 2 VVI compared with DDD group, the change of cardiac function (LVEF,NTpro-BNP) half a year after operation [LVEF (53.73 鹵5.33 VS 51.81 鹵9.38 min P 0.05)] NTpro-BNP (235.73 鹵112.20 VS, 228.63 鹵107.74 VS, P 0.05)] 2.2 one year after operation [LVEF (53.45 鹵6.74 VS, 50.37 鹵9.37, P 0.05), NTpro-BNP (257.82 鹵165.28 VS, 248.33 鹵136.74, P < 0.05)]. 3 the changes of quality of life [SF-36 (total health)] were compared between VVI group and DDD group half a year after operation [overall health (78.33 鹵9.63 VS 79.22 鹵10.29)]. Conclusion: 1, single chamber pacemaker and double chamber pacemaker implantation have no significant effect on the changes of cardiac inner diameter in elderly patients after implantation of single chamber pacemaker and double chamber pacemaker, and the changes of cardiac internal diameter were not significantly affected after implantation of single chamber pacemaker and double chamber pacemaker (P 0.05) one year after the operation [overall health (85.97 鹵6.92 VS 鹵7.75 P 0.05)]. After implantation of single chamber pacemaker and double chamber pacemaker, the ejection fraction of the heart decreased, the NTpro-BNP did not increase, and the systolic function of the heart did not decrease significantly. Both single chamber pacemaker and double chamber pacemaker implantation can significantly improve the symptoms and quality of life of the elderly patients, but there is no significant difference between the two.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7

【參考文獻】

相關期刊論文 前10條

1 周國忠;黃文軍;鐘宏;;不同起搏模式及起搏比例下患者血NT-proBNP的變化[J];江西醫(yī)藥;2015年09期

2 劉召紅;金彥青;張曉飛;;高齡患者長期置入不同類型心臟起搏器對心臟功能的影響[J];中華老年心腦血管病雜志;2015年05期

3 王陸榮;劉婷芝;成小英;;研究BNP和NT-proBNP在鑒別舒張性心力衰竭的應用價值[J];齊齊哈爾醫(yī)學院學報;2015年10期

4 孫英;;NT-proBNP在老年慢性心力衰竭患者診治中的價值[J];心血管病防治知識(學術版);2015年03期

5 袁權;;BNP和NT-proBNP在鑒別舒張性心力衰竭中的特性分析[J];中國醫(yī)藥指南;2015年06期

6 張繁之;盛國太;曹乾嬙;黃清;;不同部位起搏對正常心肌復極影響[J];江西醫(yī)藥;2014年01期

7 劉鵬;蔡淑玉;唐小龍;;心力衰竭患者Copeptin、BNP、NT-proBNP、ANP分子的檢測及其臨床意義[J];熱帶病與寄生蟲學;2013年04期

8 胡春燕;李志強;蔣慶淵;朱軍;羅心平;施海明;;高齡患者植入永久性心臟起搏器的臨床觀察[J];上海醫(yī)學;2013年10期

9 趙亞樵;;高齡患者植入永久性心臟起搏器的安全性評價[J];中國老年學雜志;2013年19期

10 古平;;起搏治療肥厚梗阻性心肌病的臨床研究[J];現(xiàn)代中西醫(yī)結合雜志;2013年27期

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