摘要
目的:探讨右心室不同部位起搏患者术后左心室收缩功能的变化.方法:收集本院2018年2月至2020年5月收治的95例需进行右心室起搏患者的临床资料,根据起搏部位的不同将其分为右室心尖部起搏(RVAP)组(n=47)以及右室间隔部起搏(RVSP)组(n=48).比较两组起搏阈值、感知阈值、电极阻抗、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、每搏量(SV)、左室射血分数(LVEF).根据术后1年是否发生心功能不全,患者被分为心功能不全组(18例)和心功能正常组(77例),分析需右心室起搏患者发生心功能不全的影响因素.结果:与术后1周比较,术后1年RVAP组感知阈值[(11.51±1.21)mV比(12.11±0.81)mV]显著升高,P=0.004.与 RVAP 组比较,术后 1 年 RVSP 组 LVESV[(25.32±7.63)ml 比(29.77±12.36)ml]、LVEDV[(58.30±15.71)ml 比(68.33±25.31)ml]、SV[(31.36±10.73)ml 比(41.29±16.15)ml]均显著升高,LVEF[(60.55±8.76)％比(54.10±6.44)％]及心功能不全比例(27.66％比 10.42％)显著降低,P＜0.05或＜0.01.非条件多因素Logistic回归模型分析显示,LVEF是需右心室起搏患者发生心功能不全的独立保护因素(OR=0.854,P=0.003),而 RVAP、年龄 ≥60 岁为其独立危险因素(OR=9.041、4.145,P=0.003、0.024).结论:与右室心尖部起搏相比,右室间隔部起搏可显著改善每搏量,心功能不全发生率显著降低.
Abstract
Objective:To investigate the changes of left ventricular systolic function in patients after pacing in differ-ent sites of right ventricle.Methods:The clinical data of 95 patients requiring right ventricular pacing who were ad-mitted to our hospital from February 2018 to May 2020 were collected.According to pacing site,they were divided into right ventricular apex pacing(RVAP)group(n=47)and right ventricular outflow tract septal pacing(RVSP)group(n=48).The pacing threshold,perception threshold,electrode impedance,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),stroke volume(SV),left ventricular ejection fraction(LVEF)were compared between the two groups.According to incidence of cardiac insufficiency on one year after pacing,patients were divided into cardiac insufficiency group(n=18)and normal cardiac function group(n=77).Influencing factors of cardiac insufficiency in patients requiring right ventricular pacing were analyzed.Results:Compared with one week after pacing,on one year after pacing,perception threshold[(11.51±1.21)mV vs.(12.11±0.81)mV]significantly increased in RVAP group,P=0.004.Compared with RVAP group on one year after pacing,there were significant rise in LVESV[(25.32±7.63)ml vs.(29.77±12.36)ml],LVEDV[(58.30±15.71)ml vs.(68.33±25.31)ml],SV[(31.36±10.73)ml vs.(41.29±16.15)ml],and significant reductions in LVEF[(60.55±8.76)％vs.(54.10±6.44)％]and proportion of cardiac insufficiency(27.66％vs.10.42％)in RVSP group,P＜0.05 or＜0.01.Non-conditional multivariate Logistic regression model analysis indicated that LVEF was inde-pendent protective factor for cardiac insufficiency in patients requiring right ventricular pacing(OR=0.854,P=0.003),while RVAP and age ≥60 years were its independent risk factors(OR=9.041,4.145,P=0.003,0.024).Conclusion:Compared with right ventricular apex pacing,right ventricular outflow tract septal pacing can significantly improve stroke volume,and incidence rate of cardiac insufficiency significantly reduces.
维普
万方数据