中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
30期
2103-2107
,共5页
董颖雪%郭萌%杨延宗%高连君%查咏梅%解泽宙%张树龙%孙颖慧%王莹琦%夏云龙%Javin Boodhna
董穎雪%郭萌%楊延宗%高連君%查詠梅%解澤宙%張樹龍%孫穎慧%王瑩琦%夏雲龍%Javin Boodhna
동영설%곽맹%양연종%고련군%사영매%해택주%장수룡%손영혜%왕형기%하운룡%Javin Boodhna
起搏器,人工%随访研究%心律失常%心脏重构
起搏器,人工%隨訪研究%心律失常%心髒重構
기박기,인공%수방연구%심률실상%심장중구
Pacemaker,artificial%Follow-up studies%Arrhythmia%Cardiac remodeling
目的 评价单腔起搏(VVI)和双腔起搏(DDD)对缓慢性心律失常患者心脏重构及远期预后的影响.方法 回顾性分析1991年1月至2003年1月植入永久性起搏器的患者的随访资料,评价VVI和DDD两种不同起搏方式患者左心系统重构与瓣膜反流、心脏功能、血栓与心房颤动事件发生率、病死率等影响情况.结果 对DDD组患者57例和VVI组患者59例,长期随访(97±27)个月、(107±44)个月发现,DDD组患者左心房、左心室内径同术前比差异无统计学意义[(37±5)mm比(35±5)mm,P=0.07;(47±7) mm比 (47±5)mm,P=0.32],三尖瓣反流率显著增加(42.1%比10.5%,P<0.01);VVI组左心房[(45±12)mm比(39±12)mm,P<0.01]、左心室[(53±11) mm比( 50±9)mm,P=0.01)]舒张末期内径较术前明显增加且三尖瓣反流率(42.4% 比 16.9%,P<0.01)显著增加;DDD组[(57±7)%比(59%±9)%,P=0.11]和VVI组患者末次随访左心室射血分数[(53±10)%比(56±11)%,P=0.05]同术前比无明显变化;末次随访时DDD组和VVI组心房颤动发生率(5.4% 比 22.0%,P=0.14)、再住院率(26.3%比33.9%,P=0.08)和病死率(10.5%比11.9%,P=0.77)差异无统计学意义.结论 两种起搏模式均不能阻止心脏电重构与机械重构的发生.提示现有的房室顺序起搏模式基础上,有必要寻求更加生理性的起搏部位或最小化心室起搏、优化房室间期等方式提高患者的预后.
目的 評價單腔起搏(VVI)和雙腔起搏(DDD)對緩慢性心律失常患者心髒重構及遠期預後的影響.方法 迴顧性分析1991年1月至2003年1月植入永久性起搏器的患者的隨訪資料,評價VVI和DDD兩種不同起搏方式患者左心繫統重構與瓣膜反流、心髒功能、血栓與心房顫動事件髮生率、病死率等影響情況.結果 對DDD組患者57例和VVI組患者59例,長期隨訪(97±27)箇月、(107±44)箇月髮現,DDD組患者左心房、左心室內徑同術前比差異無統計學意義[(37±5)mm比(35±5)mm,P=0.07;(47±7) mm比 (47±5)mm,P=0.32],三尖瓣反流率顯著增加(42.1%比10.5%,P<0.01);VVI組左心房[(45±12)mm比(39±12)mm,P<0.01]、左心室[(53±11) mm比( 50±9)mm,P=0.01)]舒張末期內徑較術前明顯增加且三尖瓣反流率(42.4% 比 16.9%,P<0.01)顯著增加;DDD組[(57±7)%比(59%±9)%,P=0.11]和VVI組患者末次隨訪左心室射血分數[(53±10)%比(56±11)%,P=0.05]同術前比無明顯變化;末次隨訪時DDD組和VVI組心房顫動髮生率(5.4% 比 22.0%,P=0.14)、再住院率(26.3%比33.9%,P=0.08)和病死率(10.5%比11.9%,P=0.77)差異無統計學意義.結論 兩種起搏模式均不能阻止心髒電重構與機械重構的髮生.提示現有的房室順序起搏模式基礎上,有必要尋求更加生理性的起搏部位或最小化心室起搏、優化房室間期等方式提高患者的預後.
목적 평개단강기박(VVI)화쌍강기박(DDD)대완만성심률실상환자심장중구급원기예후적영향.방법 회고성분석1991년1월지2003년1월식입영구성기박기적환자적수방자료,평개VVI화DDD량충불동기박방식환자좌심계통중구여판막반류、심장공능、혈전여심방전동사건발생솔、병사솔등영향정황.결과 대DDD조환자57례화VVI조환자59례,장기수방(97±27)개월、(107±44)개월발현,DDD조환자좌심방、좌심실내경동술전비차이무통계학의의[(37±5)mm비(35±5)mm,P=0.07;(47±7) mm비 (47±5)mm,P=0.32],삼첨판반류솔현저증가(42.1%비10.5%,P<0.01);VVI조좌심방[(45±12)mm비(39±12)mm,P<0.01]、좌심실[(53±11) mm비( 50±9)mm,P=0.01)]서장말기내경교술전명현증가차삼첨판반류솔(42.4% 비 16.9%,P<0.01)현저증가;DDD조[(57±7)%비(59%±9)%,P=0.11]화VVI조환자말차수방좌심실사혈분수[(53±10)%비(56±11)%,P=0.05]동술전비무명현변화;말차수방시DDD조화VVI조심방전동발생솔(5.4% 비 22.0%,P=0.14)、재주원솔(26.3%비33.9%,P=0.08)화병사솔(10.5%비11.9%,P=0.77)차이무통계학의의.결론 량충기박모식균불능조지심장전중구여궤계중구적발생.제시현유적방실순서기박모식기출상,유필요심구경가생이성적기박부위혹최소화심실기박、우화방실간기등방식제고환자적예후.
Objective To assess the effects of VVI (ventricular demand) and DDD (dual-chamber) pacing models on cardiac remodeling and the long-term clinical outcome of patients with symptomatic bradycardia.Methods All patients with DDD and VVI pacing models at our hospital from January 1991 to January 2003 were retrospectively analyzed.Results After a follow-up period of over 8 years in DDD and VVI groups (97±27, 107±44 months), left atrial diameter [(45±12) mm vs (39±12) mm, P<0.01] and left ventricular end-diastolic diameter[ (53±11) mm vs (50±9)mm, P=0.01] in 57 patients with VVI pacing model were markedly enlarged than those at pre-implantation. And tricuspid regurgitation increased (42.4% vs 16.9%, P<0.05). But in 59 patients with DDD pacing model, except for increased tricuspid regurgitation(42.1% vs 10.5%, P<0.01), left atrial diameter [(37±5) mm vs. (35±5)mm, P=0.07] and left ventricular end-diastolic diameter[(47±7)mm vs (47±5)mm, P=0.32] were not significantly different. Mitral regurgitation significantly increased only in the VVI group (P<0.01). The increases of left ventricular end-diastolic diameter (P=0.04), mitral valve (P=0.02) and tricuspid regurgitation (P<0.01) were much more pronounced in the VVI group than those in the DDD group. Left ventricular ejection fraction (LVEF) showed no difference with that at pre-implantation (P=0.11 in DDD group, P=0.05 in VVI group). But the LVEF value was lower (P=0.04) while the incidence of thrombolism was higher (P=0.03) in the VVI group than those in the DDD group at post-implantation. However, the incidence of atrial fibrillation (P=0.14), hospitalization (P=0.08) and survival (P=0.77) showed no significant difference between two groups.Conclusion DDD pacing offers more benefits over VVI pacing through improving cardiac functions and arresting left ventricular remodeling. However, neither groups showed any difference in decreasing mortality rate and hospitalization.Moreover, both pacing modes fail to reverse cardiac electrical and anatomical remodeling. It is imperative to explore more physiological pacing site and rational atrioventricular (AV) interval to improve the prognosis of patients.
