CAJ | 학술논문

目的通过监测植入起搏器患者D-二聚体水平,比较单腔、双腔和三腔(心脏再同步治疗,CRT)起搏器植入对静脉血栓形成和栓塞影响程度,以减少静脉栓塞并发症的发生.方法随机选取2010年6月～2011年6月在江苏省苏北人民医院植入起搏器患者80例,根据起搏模式分为VVI、DDD、CRT起搏器3组,分别于术前2d,术后24 h、7d监测D-二聚体水平.所有患者随访至少1年,随访期间定期监测D-二聚体水平.结果 3组患者植入起搏器后24 h D-二聚体水平较术前均增高,差异有统计学意义(P=0.029,0.026,0.003);术后7d,DDD、CRT起搏器组患者的D-二聚体水平较术前均增高,差异有统计学意义(P=0.023,0.020)；CRT起搏器组患者术后24 h D-二聚体水平较VVI、DDD起搏器组增高,差异有统计学意义[(3.76±2.68) μg/ml对(2.59±2.13) μg/ml,P=0.028;(3.76±2.68) μg/ml对(1.46±0.74)μg/ml,P=0.010].随访期间共发生2例血栓事件.结论起搏器植入可以导致机体凝血和纤溶系统的激活,通过监测D-二聚体水平,发现CRT植入术后D-二聚体水平明显高于普通起搏器.能否通过监测D-二聚体水平,判断患者凝血状态、预防血栓形成的发生,还需进一步的临床研究和证据.
목적 통과감측식입기박기환자D-이취체수평,비교단강、쌍강화삼강(심장재동보치료,CRT)기박기식입대정맥혈전형성화전새영향정도,이감소정맥전새병발증적발생.방법 수궤선취2010년6월～2011년6월재강소성소북인민의원식입기박기환자80례,근거기박모식분위VVI、DDD、CRT기박기3조,분별우술전2d,술후24 h、7d감측D-이취체수평.소유환자수방지소1년,수방기간정기감측D-이취체수평.결과 3조환자식입기박기후24 h D-이취체수평교술전균증고,차이유통계학의의(P=0.029,0.026,0.003);술후7d,DDD、CRT기박기조환자적D-이취체수평교술전균증고,차이유통계학의의(P=0.023,0.020)；CRT기박기조환자술후24 h D-이취체수평교VVI、DDD기박기조증고,차이유통계학의의[(3.76±2.68) μg/ml대(2.59±2.13) μg/ml,P=0.028;(3.76±2.68) μg/ml대(1.46±0.74)μg/ml,P=0.010].수방기간공발생2례혈전사건.결론 기박기식입가이도치궤체응혈화섬용계통적격활,통과감측D-이취체수평,발현CRT식입술후D-이취체수평명현고우보통기박기.능부통과감측D-이취체수평,판단환자응혈상태、예방혈전형성적발생,환수진일보적림상연구화증거.
Objective Venous lesions,including obstruction and thromboembolism (VTE),were common after pacemaker implantation.This study was arm to assess the effects of various permanent transvenous pacemakers on serum levels of D-dimer(D-D),including single-chamber,dual-chamber and cardiac resynchronization therapy(CRT) devices and reduce complications of venous thrombosis.Methods Eighty patients with pacemaker implantations were enrolled in this study according to the mode of pacing.The blood samples were harvested before implantation,24 hours and 7 days after implantation,respectively.Results Compared with the levels of D-D preimplantation,the levels of D-D in all the groups increased significantly after implantation(P=0.029,0.026,0.003).Compared with the levels of D-D preimplantation,the levels of D-D in patients with CRT and dual-chamber group increased significantly 7 days after implantation (P =0.023,0.020).Compared with the levels of D-D in patients with single and dual-chamber,the levels of D-D in patients with CRT elevated significantly 24 hours after implantation[(3.76±2.68)μg/ml vs(2.59±2.13) μg/ml,P =0.028; (3.76±2.68)μg/ml vs (1.46 ± 0.74) μg/ml,P =0.010].During the follow-up,there were two patients had thrombus.Conclusions Permanent transvenous pacemakers can lead to underlying abnormalities in the coagulation-fibrinolysis system.The levels of D-D in patients with CRT were increased remarkably after implantation.