全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2014年
3期
250-252,259
,共4页
起搏比例%右室心尖部起搏%右室间隔部起搏%心功能%老年人
起搏比例%右室心尖部起搏%右室間隔部起搏%心功能%老年人
기박비례%우실심첨부기박%우실간격부기박%심공능%노년인
percentage of right ventricular pacing%RVA pacing%RVS pacing%cardiac function%elderly
目的：探讨右心室起搏比例和不同部位起搏对老年患者心功能的影响。方法回顾性分析92例植入体内埋藏式双腔心脏起搏器（DDD）的老年患者的临床资料，根据术后1年起搏器程控仪获取的右心室起搏比例，将右心室起搏比例≥50%患者纳入A组，右心室起搏比例＜50%患者纳入B组，比较两组术前和术后1年彩色多普勒心脏超声的变化。同时，将A组分为右室心尖部（RVA）起搏者和右室间隔部（RVS）起搏者进行亚组分析。结果 A组术后1年左房内径（LAD）较术前增大，左室射血分数（LVEF）较术前和B组降低，差异均有统计学意义（t分别=2.43、4.20、6.37，P均＜0.05）；B组术后1年LAD、左室舒张末期内径（LVEDD）、LVEF和术前比较，差异均无统计学意义（t分别=0.73、0.78、1.16，P均＞0.05）。亚组分析结果显示两亚组术前LAD、LVEDD、LVEF比较，差异均无统计学意义（t分别=0.77、0.35、1.32，P均＞0.05），两组术后LVEDD、LVEF比较，差异均有统计学意义（t分别=2.86、4.62，P均＜0.05），RVS组术后LAD、LVEDD、LVEF与术前比较，差异均无统计学意义（t分别=1.45、0.14、0.48，P均＞0.05）；而RVA组术后LAD、LVEDD均较术前明显扩大，LVEF较术前明显下降（t分别=2.20、3.13、4.31，P均＜0.05）。结论老年患者中右室间隔部起搏与右室心尖部起搏相比更有利于保持患者心功能的稳定，但同时应尽量减少不必要的右心室起搏。
目的：探討右心室起搏比例和不同部位起搏對老年患者心功能的影響。方法迴顧性分析92例植入體內埋藏式雙腔心髒起搏器（DDD）的老年患者的臨床資料，根據術後1年起搏器程控儀穫取的右心室起搏比例，將右心室起搏比例≥50%患者納入A組，右心室起搏比例＜50%患者納入B組，比較兩組術前和術後1年綵色多普勒心髒超聲的變化。同時，將A組分為右室心尖部（RVA）起搏者和右室間隔部（RVS）起搏者進行亞組分析。結果 A組術後1年左房內徑（LAD）較術前增大，左室射血分數（LVEF）較術前和B組降低，差異均有統計學意義（t分彆=2.43、4.20、6.37，P均＜0.05）；B組術後1年LAD、左室舒張末期內徑（LVEDD）、LVEF和術前比較，差異均無統計學意義（t分彆=0.73、0.78、1.16，P均＞0.05）。亞組分析結果顯示兩亞組術前LAD、LVEDD、LVEF比較，差異均無統計學意義（t分彆=0.77、0.35、1.32，P均＞0.05），兩組術後LVEDD、LVEF比較，差異均有統計學意義（t分彆=2.86、4.62，P均＜0.05），RVS組術後LAD、LVEDD、LVEF與術前比較，差異均無統計學意義（t分彆=1.45、0.14、0.48，P均＞0.05）；而RVA組術後LAD、LVEDD均較術前明顯擴大，LVEF較術前明顯下降（t分彆=2.20、3.13、4.31，P均＜0.05）。結論老年患者中右室間隔部起搏與右室心尖部起搏相比更有利于保持患者心功能的穩定，但同時應儘量減少不必要的右心室起搏。
목적：탐토우심실기박비례화불동부위기박대노년환자심공능적영향。방법회고성분석92례식입체내매장식쌍강심장기박기（DDD）적노년환자적림상자료，근거술후1년기박기정공의획취적우심실기박비례，장우심실기박비례≥50%환자납입A조，우심실기박비례＜50%환자납입B조，비교량조술전화술후1년채색다보륵심장초성적변화。동시，장A조분위우실심첨부（RVA）기박자화우실간격부（RVS）기박자진행아조분석。결과 A조술후1년좌방내경（LAD）교술전증대，좌실사혈분수（LVEF）교술전화B조강저，차이균유통계학의의（t분별=2.43、4.20、6.37，P균＜0.05）；B조술후1년LAD、좌실서장말기내경（LVEDD）、LVEF화술전비교，차이균무통계학의의（t분별=0.73、0.78、1.16，P균＞0.05）。아조분석결과현시량아조술전LAD、LVEDD、LVEF비교，차이균무통계학의의（t분별=0.77、0.35、1.32，P균＞0.05），량조술후LVEDD、LVEF비교，차이균유통계학의의（t분별=2.86、4.62，P균＜0.05），RVS조술후LAD、LVEDD、LVEF여술전비교，차이균무통계학의의（t분별=1.45、0.14、0.48，P균＞0.05）；이RVA조술후LAD、LVEDD균교술전명현확대，LVEF교술전명현하강（t분별=2.20、3.13、4.31，P균＜0.05）。결론노년환자중우실간격부기박여우실심첨부기박상비경유리우보지환자심공능적은정，단동시응진량감소불필요적우심실기박。
Objective To investigate the effect of percentage right ventricular pacing (%RVP) and different pacing area on cardiac function in elderly patients. Methods A total of 92 elderly patients with dual-chamber pacemakers (DDD) were divided into two groups according to %RVP at first year after implantation of pacemakers. The patients whose %RVP≥50%were selected into group A while%RVP<50%were selected into group B. Echocardiographic parameters were measured by two-dimensional pulsed Doppler echocardiography and compared before and after operation. Furthermore, the group A were divided into right ventricular septum (RVS) pacing and right ventricular apex (RVA) pacing for subgroup analyzing. Results Left atrial diameter (LAD) in group A was significantly larger than in group B, Left ventricular ejection fraction (LVEF)was significantly lower than pre-operation and LVEF was significantly lower than group B (t=2.43, 4.20, 6.37,P<0.05). Compared with pre-operation, LAD, left ventricular end diastolic dimension (LVEDD)and LVEF post-operation in group B were not significantly different (t=0.73, 0.78, 1.16, P>0.05). Subgroup analysis showed that LAD, LVEDD and LVEF between two groups at pre-operation had no statistical difference (t=0.77, 0.35, 1.32,P>0.05). LVEDD and LVEF had significantly difference between RVA pacing group and RVS pacing group at post-operation (t=2.86, 4.62,P<0.05). LAD , LVEDD and LVEF in RVS pacing group were not significantly enlarged when compared pre-operation with post-operation (t=1.45, 0.14, 0.48,P>0.05). LAD and LVEDD at post-operation were significantly larger than that at pre-operation while LVEF was significantly lower (t=2.20, 3.13, 4.31,P<0.05). Conclusions Compared to RVA pacing,RVS pacing has more advantage on cardiac function in elderly patients. But it should be reduce unnecessary right ventricular pacing.
