【作者】 李耀东；

【导师】 汤宝鹏；

【作者基本信息】 新疆医科大学 ， 内科学， 2008， 硕士

【摘要】 目的病态窦房结综合征患者起搏器植入后,观察心脏血液动力学指标的变化,以探讨不同起搏模式对心功能的长期影响。方法经临床食管心房调搏动态心电图和运动试验确诊病态窦房结综合征患者,择期植入永久双腔起搏器,随机植入AAI起搏器(n=92例)DDD起搏器(n=93例),采用心脏超声观察185例病态窦房结综合征患者术前,术后1、2、5年的左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)及左室射血分数(LVEF)的变化;术后1,2及5年程控起搏器观察DDD起搏组右室起搏累积百分比(VP%)。比较两种起搏方式对左心功能的影响及右室起搏累积百分比与心功能变化的关系。结果AAI起搏组术前,术后1、2、5年随访的LVEDV,LVESV及LVEF比较无统计学差异,DDD起搏组第5年随访的LVESV明显增加(F=42.07,p<0.05),LVEF降低(F=6.78,P<0.05),有统计学差异。术后5年DDD起搏组高VP%使LVESV明显增加(p<0.05),LVEF降低(P<0.05)。结论DDD起搏高比例的右室起搏将房室同步性的优势全部抵消。DDD起搏并非生理性起搏,长期DDD起搏可对患者的左心功能造成损害。更多还原

【Abstract】 Objective To investigate different pacing modes on the long-term effects of cardiac function. Methods 185 patients with SSS in terms of clinical manifestation, Holter and Esophageal atrial pacing underwent the different pacing. The Left ventricular end-diastolic volume(LVEDV)? Left ventricular end-systolic volume (LVESV) and Left ventricular ejection fraction(LVEF) were measured by the echocardiography before and after implantation of pacemaker and follow-up 1-5 years. Program-controlled observation DDD pacemaker to observe Percentage of right ventricular pacing(VP %) after implantation. Among them,92 cases were implanted with AAI pacemaker, and 93 cases with DDD pacemaker. Result The indexes of structural remodeling and percentage of right ventricular pacing (VP %)were increased(P<0.05), left ventricular ejection fraction(LVEF) significantly decreased(P<0.05)in DDD cases after follow-up 1-5 years. Conclusion DDD pacing is not physiological pacing, which can be long-term in patients with left ventricular function damage.更多还原