余莉芳

【摘要】 目的：了解Ⅲ度房室傳导阻滞行DDD起搏后的心功能变化，为临床提供有效的心脏起搏方式。方法：136例Ⅲ度房室传导阻滞患者被分为VVI组66例和DDD组70例，两组置入的心脏起搏器分别为心室抑制型起搏（单腔起搏，VVI）和全自动双腔起搏（DDD）。两组在术前和术后1年时观察以下指标：左室收缩末径（LVDs）、左室舒张末径（ LVDd）、左房内径（LAD）、左心室后壁厚度（LVPWT）、室间隔厚度（IVS）、室壁增厚率（ΔT %）、左心室短轴缩短率（ΔD%），左室射血分数（LVEF）、心脏指数（CI）、体循环血管阻力（SVR）、BNP水平。结果：术后1年，VVI组LVDd、LAD均明显高于术前，差异均有统计学意义（t=5.199、4.748， P<0.05）；术后1年，VVI组LAD显著高于DDD组，差异有统计学意义（t=3.640，P<0.05）。术后1年，两组BNP水平均比术前明显升高，差异均有统计学意义（t=13.273、26.711，P<0.05）；VVI组术后LVEF、CI均比术前明显下降，差异均有统计学意义（t=7.881、6.218，P<0.05）；术后1年，VVI组LVEF显著低于DDD组， BNP显著高于DDD组，差异均有统计学意义（t=5.905、11.853，P<0.05）。在随访期间，VVI组心房颤动发生率为37.88 % （25/66），DDD组为8.57 % （6/70），差异有统计学意义（字2=16.580，P<0.05）；VVI组缺血性脑卒中发生率为4.55%（3/66），DDD组为2.86%（2/70），差异无统计学意义（字2=0.273，P>0.05）。结论：对于Ⅲ度房室传导阻滞患者，DDD起搏对心功能的影响更小，且术后心房颤动发生率更低，具有良好的临床应用价值。

【关键词】 Ⅲ度房室传导阻滞； VVI起搏； DDD起搏； 左室射血分数； 血脑钠素

doi：10.14033/j.cnki.cfmr.2017.31.071 文献标识码 B 文章编号 1674-6805（2017）31-0142-04

【Abstract】 Objective：To learn the changes of cardiac function after DDD pacing on third degree atrioventricular block，and to provide an effective way of cardiac pacing.Method：136 cases with third degree atrioventricular block were divided into VVI group of 66 cases and DDD group of 70 cases，implanted cardiac pacemaker of the two groups were respectively ventricular inhibited pacing（single chamber pacing，VVI） and automatic dual chamber pacing（DDD）.In preoperative and postoperative 1 year the following indicators of the two groups were observed：left ventricular end systolic diameter （LVDS），left ventricular end diastolic diameter （LVDD），left atrial diameter （LAD），left ventricular posterior wall thickness（LVPWT），interventricular septal thickness（IVS），ventricular wall thickening rate（ΔT%）and left ventricular short axis shortening（Δd%），left ventricular ejection fraction （LVEF），cardiac index （CI），systemic vascular resistance（SVR），brain natriuretic peptide （BNP） level.Result：1 year after surgery，LVDd and LAD of VVI group were significantly higher than preoperative，the differences were statistically significant（t=5.199，4.748，P<0.05）.1 year after operation，LAD of VVI group was significantly higher than that of DDD group，the difference was statistically significant（t=3.640，P<0.05）.1 year after operation，compared with preoperative，BNP level of two groups were increased significantly，the differences were statistically significant （t=13.273，26.711，P<0.05）.Compared with preoperative，LVEF and CI of VVI group were decreased significantly，the differences were statistically significant（t=7.881，6.218，P<0.05）.1 year after surgery，LVEF of VVI group was significantly lower than that of DDD group，BNP of VVI group was significantly higher than that of DDD group，the differences were statistically significant（t=5.905，11.853，P<0.05）.During the follow-up period，atrial fibrillation incidence of VVI group was 37.88% （25/66），atrial fibrillation incidence of DDD group was 8.57% （6/70），the difference was statistically significant （字2=16.580，P<0.05）.Ischemic stroke incidence of VVI group was 4.55%（3/66），ischemic stroke incidence of DDD group was 2.86% （2/70），the differences was not significant（字2=0.273，P>0.05）.Conclusion：For patients with third degree atrioventricular block，the effect of DDD pacing on cardiac function is smaller，and the incidence of postoperative atrial fibrillation is lower，which has a good clinical value.endprint

【Key words】 Third degree atrioventricular block； VVI pacing； DDD pacing； Left ventricular ejection fraction； Brain natriuretic peptide

First-authors address：Shao yifu Hospital Affiliated to Zhejiang University Medical School，Hangzhou 310016，China

近年来研究表明，Ⅲ度房室传导阻滞最有效的治疗方法是置入埋藏式人工心脏起搏器，最常用的置入的心脏起搏器类型为心室抑制型起搏（单腔起搏，VVI）和全自動双腔起搏（DDD）[1-4]。置入人工心脏起搏器后对患者心功能及血流动力学的影响是心脏起搏器的研究重点。正常的心房收缩所形成的辅助泵作用能有效提高患者心室舒张末期的左心室充盈量，采用超声心动图等检查显示，与心室单腔起搏相比，心脏双腔起搏能获得更理想的血流动力学状况[5-6]。脑钠素（brain natriuretic peptide，BNP）是人体心室肌细胞分泌的一种肽类活性因子，多项研究表明认为BNP可较好地反映出血流动力学状况，可作为患者血流动力学监测的指标[7]。……