發(fā)布時(shí)間：2019-01-12 11:14

【摘要】：目的:評(píng)價(jià)不同的心臟起搏模式(VVI與DDD)對(duì)高齡起搏器植入患者預(yù)后的影響。方法:入選我院(馬鞍山市人民醫(yī)院)60例因心臟傳導(dǎo)系統(tǒng)疾病(房室傳導(dǎo)阻滯、心房顫動(dòng)伴房室傳導(dǎo)阻滯或長(zhǎng)間歇、病態(tài)竇房結(jié)綜合征等緩慢性心律失常)植入永久心臟起搏器的高齡患者,按照植入起搏器的類型,分為雙腔起搏器(DDD)組27例和單腔起搏器(VVI)組33例。采用多普勒心臟彩超、N末端腦鈉肽原(NT-pro BNP)和SF-36生活質(zhì)量調(diào)查表為觀察手段,評(píng)估兩組患者術(shù)前、術(shù)后一年的左房舒張末期內(nèi)徑(LAEDD)、左室舒張末期內(nèi)徑(LVEDD)和左室收縮末期內(nèi)徑(LVESD)3個(gè)心臟內(nèi)徑指標(biāo)、左室射血分?jǐn)?shù)(LVEF)、N末端腦鈉肽原(NT-pro BNP)以及SF-36生活質(zhì)量調(diào)查表的評(píng)分條目,通過(guò)上訴起搏器植入前后的指標(biāo)比較兩組患者心功能和生活質(zhì)量的變化。結(jié)果:1 VVI與DDD兩組相比,術(shù)后半年、術(shù)后一年的心臟內(nèi)徑(LAEDD、LVEDD、LVESD)的變化1.1術(shù)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術(shù)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與DDD兩組相比,術(shù)后半年、術(shù)后一年的心功能(LVEF、NTpro-BNP)的變化2.1術(shù)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術(shù)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兩組相比,生活質(zhì)量[SF-36(總體健康)]的變化3.1術(shù)后半年[總體健康(78.33±9.63 VS 79.22±10.29,P0.05)]3.2術(shù)后一年[總體健康(85.97±6.92 VS 86.15±7.75,P0.05)]結(jié)論:1、單腔起搏器和雙腔起搏器植入后對(duì)高齡患者心臟內(nèi)徑的變化無(wú)明顯影響。2、單腔起搏器和雙腔起搏器植入后高齡患者心臟射血分?jǐn)?shù)下降、NTpro-BNP升高均不明顯,心臟收縮功能無(wú)明顯減低。3、單腔起搏器和雙腔起搏器植入后都能明顯改善高齡患者的癥狀,提高患者的生活質(zhì)量,但是兩者對(duì)比無(wú)明顯差異。
[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 鹵7.57 VS, 39.59 鹵4.80 VS, P 0.05, 50.9 鹵5.53 VS, 52.30 鹵5.68), respectively] half a year after operation [LAEDD (40.52 鹵7.57 VS, 39.59 鹵4.80)]; P05), LVESD (38.06 鹵3.70 VS39.44 鹵6.76 VS39.44] 1.2 one year after operation [LAEDD (42.00 鹵6.77 VS, 41.15 鹵6.05 VS, P0.05), LVEDD (50.39 鹵5.77 VS 53.74 鹵8.66, P0.05)], LVESD (38.64 鹵5.52 VS41.41 鹵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 鹵5.33 VS 51.81 鹵9.38 min P 0.05)] NTpro-BNP (235.73 鹵112.20 VS, 228.63 鹵107.74 VS, P 0.05)] 2.2 one year after operation [LVEF (53.45 鹵6.74 VS, 50.37 鹵9.37, P 0.05), NTpro-BNP (257.82 鹵165.28 VS, 248.33 鹵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 鹵9.63 VS 79.22 鹵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 鹵6.92 VS 鹵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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.7

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