右室流出道间隔部起搏QRS时限对原有心功能不全患者影响的比较

摘要

Objective:To observe the effects of paced QRS duration(pQRSd) on cardiac function in right ventricular outflow tract(RVOT) pacing patients who have slow arrhythmia requiring permanent pacemaker therapy associated with cardiac dysfunction.Method:52 patients associated with cardiac dysfunction,performed with right ventricular outflow tract paced,and the percentage of ventricular paced were greater than 90%,they were divided into A group(pQRSd<180 ms) and B group(pQRSd≥180 ms).NT-pro-BNP、LVEDD、LVESD、LVEF were analyzed and compared between two groups immediately after operation and 3 months after operation and observed the changes of cardiac function in patients.Result:NT-pro-BNP and cardiac ultrasound index of the two groups before operation were not statistically significant differences(P>0.05).After operation 3 months,the NT-pro-BNP,LVEDD,LVESD indexes of B group were significantly higher than those in A group,and the LVEF group of B was lower than A group,the differences were statistically significant (P<0.05).During pacemaker implantation, 3 months after surgery,two groups of patients with pacing threshold and lead impedance,R wave height,there were no significant differences (P>0.05).Conclusion:Patients with heart failure and need to be fitted with permanent cardiac pacemaker,RVOT interval paced QRS duration and postoperative cardiac function are closely related,pQRSd is wider,the heart function is poorer.%目的：探讨右心室流出道（right ventricular outflow trace，RVOT）间隔部起搏QRS波时限对缓慢型心律失常伴有心功能不全患者心脏收缩功能的影响。方法：选取采用右心室间隔部起搏治疗，心室起搏比例均大于90%，并且术前合并心功能不全的患者52例。按患者起搏时QRS波时限（paced QRS duration，pQRSd）分为两组，QRS波时限<180 ms的为A组（n=26），起搏时QRS波时限≥180 ms的为B组（n=26）。测量并比较起搏器植入前和术后3个月两个不同时期的血浆N端-B型脑钠肽原（NT-pro-BNP）、左室收缩末内径（LVESD）、左室舒张末内径（LVEDD）、左室射血分数（LVEF）、起搏参数变化。结果：术前两组的NT-pro-BNP值和心脏超声指标比较，差异均无统计学意义（P>0.05）；术后3个月B组的NT-pro-BNP、LVEDD、LVESD指标均明显高于A组，B组的LVEF低于A组，差异均有统计学意义（P<0.05）；起搏器置入时、术后3个月两组患者起搏阀值、导线阻抗、R波高度等比较，差异均无统计学意义（P>0.05）。结论：对于伴有心功能不全并且需要安装心脏永起搏器的患者，RVOT间隔部起搏QRS波时限和术后心功能密切相关，pQRSd越宽，心功能越差。