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不同的心脏起搏模式对高龄起搏器植入患者预后的影响

发布时间:2019-01-12 11:14  文章来源:笔耕文化传播
【摘要】:目的:评价不同的心脏起搏模式(VVI与DDD)对高龄起搏器植入患者预后的影响。方法:入选我院(马鞍山市人民医院)60例因心脏传导系统疾病(房室传导阻滞、心房颤动伴房室传导阻滞或长间歇、病态窦房结综合征等缓慢性心律失常)植入永久心脏起搏器的高龄患者,按照植入起搏器的类型,分为双腔起搏器(DDD)组27例和单腔起搏器(VVI)组33例。采用多普勒心脏彩超、N末端脑钠肽原(NT-pro BNP)和SF-36生活质量调查表为观察手段,评估两组患者术前、术后一年的左房舒张末期内径(LAEDD)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)3个心脏内径指标、左室射血分数(LVEF)、N末端脑钠肽原(NT-pro BNP)以及SF-36生活质量调查表的评分条目,通过上诉起搏器植入前后的指标比较两组患者心功能和生活质量的变化。结果:1 VVI与DDD两组相比,术后半年、术后一年的心脏内径(LAEDD、LVEDD、LVESD)的变化1.1术后半年[LAEDD(40.52±7.57 VS 39.59±4.80,P0.05),LVEDD(50.9±5.53 VS 52.30±5.68,P0.05),LVESD(38.06±3.70 VS39.44±6.76,P0.05)]1.2术后一年[LAEDD(42.00±6.77 VS 41.15±6.05,P0.05),LVEDD(50.39±5.77 VS 53.74±8.66,P0.05),LVESD(38.64±5.52 VS41.41±9.22,P0.05)]2 VVI与DDD两组相比,术后半年、术后一年的心功能(LVEF、NTpro-BNP)的变化2.1术后半年[LVEF(53.73±5.33 VS 51.81±9.38,P0.05),NTpro-BNP(235.73±112.20 VS 228.63±107.74,P0.05)]2.2术后一年[LVEF(53.45±6.74 VS 50.37±9.37,P0.05),NTpro-BNP(257.82±165.28 VS 248.33±136.74,P0.05)]3 VVI和DDD两组相比,生活质量[SF-36(总体健康)]的变化3.1术后半年[总体健康(78.33±9.63 VS 79.22±10.29,P0.05)]3.2术后一年[总体健康(85.97±6.92 VS 86.15±7.75,P0.05)]结论:1、单腔起搏器和双腔起搏器植入后对高龄患者心脏内径的变化无明显影响。2、单腔起搏器和双腔起搏器植入后高龄患者心脏射血分数下降、NTpro-BNP升高均不明显,心脏收缩功能无明显减低。3、单腔起搏器和双腔起搏器植入后都能明显改善高龄患者的症状,提高患者的生活质量,但是两者对比无明显差异。
[Abstract]:Objective: to evaluate the effect of different pacing modes (VVI and DDD) on the prognosis of elderly patients with pacemaker implantation. Methods: sixty patients with heart conduction system diseases (atrioventricular block, atrial fibrillation with atrioventricular block or long interval) were enrolled in our hospital (Ma'anshan people's Hospital). According to the type of pacemaker implanted, the elderly patients were divided into two groups: double chamber pacemaker (DDD) group (n = 27) and single chamber pacemaker (VVI) group (n = 33). Doppler echocardiography, N-terminal brain natriuretic peptide (NT-pro BNP) and SF-36 quality of life questionnaire were used to evaluate left atrial end-diastolic diameter (LAEDD),) before and one year after operation. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), N) end brain natriuretic peptide (NT-pro BNP), and SF-36 quality of life (QOL) were measured. The changes of cardiac function and quality of life were compared between the two groups before and after pacemaker implantation. Results: 1Compared with DDD group, the changes of cardiac diameter (LAEDD,LVEDD,LVESD) half a year after operation in VVI group and DDD group [LAEDD (40.52 卤7.57 VS, 39.59 卤4.80 VS, P 0.05, 50.9 卤5.53 VS, 52.30 卤5.68), respectively] half a year after operation [LAEDD (40.52 卤7.57 VS, 39.59 卤4.80)]; P05), LVESD (38.06 卤3.70 VS39.44 卤6.76 VS39.44] 1.2 one year after operation [LAEDD (42.00 卤6.77 VS, 41.15 卤6.05 VS, P0.05), LVEDD (50.39 卤5.77 VS 53.74 卤8.66, P0.05)], LVESD (38.64 卤5.52 VS41.41 卤9.22 VS41.41)] 2 VVI compared with DDD group, the change of cardiac function (LVEF,NTpro-BNP) half a year after operation [LVEF (53.73 卤5.33 VS 51.81 卤9.38 min P 0.05)] NTpro-BNP (235.73 卤112.20 VS, 228.63 卤107.74 VS, P 0.05)] 2.2 one year after operation [LVEF (53.45 卤6.74 VS, 50.37 卤9.37, P 0.05), NTpro-BNP (257.82 卤165.28 VS, 248.33 卤136.74, P < 0.05)]. 3 the changes of quality of life [SF-36 (total health)] were compared between VVI group and DDD group half a year after operation [overall health (78.33 卤9.63 VS 79.22 卤10.29)]. Conclusion: 1, single chamber pacemaker and double chamber pacemaker implantation have no significant effect on the changes of cardiac inner diameter in elderly patients after implantation of single chamber pacemaker and double chamber pacemaker, and the changes of cardiac internal diameter were not significantly affected after implantation of single chamber pacemaker and double chamber pacemaker (P 0.05) one year after the operation [overall health (85.97 卤6.92 VS 卤7.75 P 0.05)]. After implantation of single chamber pacemaker and double chamber pacemaker, the ejection fraction of the heart decreased, the NTpro-BNP did not increase, and the systolic function of the heart did not decrease significantly. Both single chamber pacemaker and double chamber pacemaker implantation can significantly improve the symptoms and quality of life of the elderly patients, but there is no significant difference between the two.
【学位授予单位】:皖南医学院
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R541.7

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