【摘要】：目的:運(yùn)用超聲心動(dòng)圖(ultrasonic cardiogram,UCG)評(píng)價(jià)右室心尖部(right ventricular apical,RVA)起搏及右室間隔部(right ventricular septal,RVS)起搏對(duì)完全性房室傳導(dǎo)阻滯患者左室、左房收縮功能的影響,并觀察兩組患者的血漿腦鈉肽(brain natriuretic peptide,BNP)水平的變化,研究植入埋藏式心臟起搏器術(shù)后左室收縮功能與血漿BNP之間是否具有相關(guān)性。方法:將具備埋藏式心臟起搏器植入適應(yīng)證的51例完全性房室傳導(dǎo)阻滯患者隨機(jī)分為RVA起搏組(RVA組,20例)和RVS起搏組(RVS組,31例),分別于術(shù)前、術(shù)后1、3、6及12個(gè)月采用二維超聲心動(dòng)圖Simpson法測(cè)定所有患者的左室射血分?jǐn)?shù)(ejection fraction of left ventricle,LVEF)及左房射血分?jǐn)?shù)(ejection fraction of left atrial,LAEF),同時(shí)測(cè)定患者血漿BNP值。結(jié)果:兩組LVEF術(shù)后12個(gè)月較術(shù)前、術(shù)后1個(gè)月、術(shù)后3個(gè)月有所恢復(fù)(P0.01);兩組LAEF術(shù)后6個(gè)月、12個(gè)月較術(shù)前、術(shù)后1個(gè)月、術(shù)后3個(gè)月有所恢復(fù)(P0.01);RVS組術(shù)后6個(gè)月、12個(gè)月LAEF恢復(fù)程度優(yōu)于RVA組(P0.01);RVS組術(shù)后12個(gè)月LVEF恢復(fù)程度優(yōu)于RVA組(P0.01)。所有患者LVEF與BNP水平呈負(fù)相關(guān)(r=-0.51,P0.05)。RVS組術(shù)后BNP水平低于RVA組(P0.01),RVS組術(shù)前、術(shù)后BNP水平不同時(shí)間點(diǎn)之間有差異(P0.01)。結(jié)論:RVS起搏較RVA起搏更有利于左室及左房射血功能恢復(fù),可能是更為理想的右室起搏部位。血漿BNP水平與LVEF具有相關(guān)性,可在一定程度上反映心臟起搏器安置術(shù)后患者左室收縮功能的恢復(fù)情況。
[Abstract]:Objective: to evaluate the effects of right ventricular apex (right ventricular apical,RVA) pacing and right ventricular septal (right ventricular septal,RVS) pacing on left ventricular and left atrial systolic function in patients with complete atrioventricular block by echocardiography (ultrasonic cardiogram,UCG). The changes of plasma brain natriuretic peptide (brain natriuretic peptide,BNP) levels in two groups were observed to investigate the correlation between left ventricular systolic function and plasma BNP after implantation of implantable pacemaker. Methods: Fifty-one patients with complete atrioventricular block were randomly divided into RVA pacing group (RVA group, n = 20) and RVS pacing group (RVS group, n = 31). Left ventricular ejection fraction (ejection fraction of left ventricle,LVEF) and left atrial ejection fraction (ejection fraction of left atrial,LAEF) were measured by two-dimensional echocardiography (Simpson) and plasma BNP at 6 and 12 months. Results: LVEF in both groups recovered 12 months after operation, 1 month after operation, 3 months after operation (P0.01), 6 months, 12 months after operation, 1 month after operation and 3 months after LAEF in both groups (P0.01). The recovery degree of LAEF in RVS group was better than that in RVA group at 6 months and 12 months after operation (P0.01); RVS group was better than RVA group in LVEF recovery at 12 months after operation (P0.01). There was a negative correlation between LVEF and BNP level in all patients (r-0.51p0.05 BNP level in). RVS group was lower than that in RVA group (P0.01), RVS group, there was significant difference in BNP level between different time points after operation (P0.01). Conclusion: RVS pacing is more beneficial to the recovery of left ventricular and left atrial ejection function than RVA pacing, and may be a more ideal right ventricular pacing site. Plasma BNP level was correlated with LVEF, which could reflect the recovery of left ventricular systolic function after pacemaker implantation.
【作者單位】： 貴州省人民醫(yī)院心內(nèi)科;
【基金】：貴州省優(yōu)秀科技教育人才省長(zhǎng)專項(xiàng)資金資助項(xiàng)目(No:2012-12) 貴州省衛(wèi)生計(jì)生委科學(xué)技術(shù)基金(No:GZWKJ2014-1-047)
【分類號(hào)】：R541.7

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