自身房室传导搜索功能对心室起搏百分比影响.docVIP

自身房室传导搜索功能对心室起搏百分比影响[摘要] 目的：探讨双腔起搏器使用自身房室传导搜索功能（autointrinsic conduction search，AICS）对右心室起搏百分比的影响。方法：选取本院2008年6月~2011年6月成功植入St Jude公司双腔起搏器（型号为5376或5386）的患者50例。分别观察打开和关闭AICS功能1个月后患者右心室起搏百分比的变化及测试血浆脑利钠肽（BNP）值。结果：使用AICS功能后，与关闭AICS功能后比较，心室起搏比例明显下降[（4.2±1.3）% vs （43.3±7.1）%]，BNP水平亦明显降低[（57.3±22.4）pg/ml vs （377.7±42.5）pg/ml]，差异有高度统计学意义（P＜0.01）。结论：双腔起搏器使用自身房室传导搜索功能可明显减少心室起搏百分比，鼓励自身房室传导，减少起搏器电池耗竭，改善心功能。 [关键词] 双腔起搏器；自身房室传导搜索；心室起搏比例；脑利钠肽 [中图分类号] R541 [文献标识码] B [文章编号] 1673-7210（2011）12（b）-162-02 Effect of autointrinsic conduction search fuction on ventricular pacing percentage WANG Wei, YANG Xili, LI Jianmin Department of Cardiology, the First People’s Hospital of Foshan City, Guangdong Province, Foshan 528000, China [Abstract] Objective: To assess the efficacy of the decrease of right ventricular pacing percentage by the dual-chamber pacemaker with autointrinsic conduction search (AICS). Methods: A total number of fifty patients implanted St Jude’s DDD or DDDR (5376 or 5386) from June 2008 to June 2011 in our hospital. The percentages of right ventricular pacing were interrogated when the AICS functions were programmed “on” or “off” for 1 month. At the same time, plasma BNP levels were recorded. Results: The percentages of 50 patients’ right ventricular pacing when using AICS fuction were decreased significantly [(4.2±1.3)% vs (43.3±7.1)%], plasma BNP levels were also significantly reduced [(57.3±22.4) pg/ml vs (377.7±42.5) pg/ml], the difference was statistically significant (P0.05]，BNP水平亦明显降低[（57.3±22.4）pg/ml vs （377.7±42.5）pg/ml，P 表1 AICS功能打开/关闭后心房心室起搏百分比及BNP比较（x±s） 注：与AICS关闭组比，aP＜0.01 3 讨论 右室心尖部起搏是长期以来永久性人工心脏起搏器植入的主要途径。起搏时，右室心尖部最先激动，造成人为的左束支传导阻滞，使整个心室收缩形态和起始方向与正常窦性节律时截然相反，致使心室收缩和舒张失同步，并导致二尖瓣乳头肌收缩不协调，二尖瓣反流，从而不同程度的损伤心功能。Lee等[2]对长期右室心尖部起搏的犬进行核素心室造影，发现其左室舒张功能减退。Nielsen等[3]也在临床上证实了长期右室心尖部起搏导致节段性心肌缺血，造成左室功能下降。MOST研究证实[4-5]心室累积起搏比例升高导致心功能不全的发生和恶化比例明显增加[6]，而且房颤及室速、室颤的发生亦有增加。Andersen等[7-8]研究发现与心房起搏相比，在心室起搏比例高的患者中发生脑卒中、心功能不全的比例明显增高。这些不同研究均