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生理性心脏起搏的临床分析
作者:叶行舟 任利群 智宏 王惠萍 王润明 陆静 
单位:东南大学附属中大医院,心内科,江苏,南京,210009
关键词:生理性起搏 非生理性起搏 心功能 房颤 
分类号:R654.2
出版年·卷·期(页码):2007·26·第一期(46-48)
摘要:

目的:分析生理性起搏治疗各种缓慢性心律失常,改善患者心功能及生活质量的临床效果.方法:1999年8月到2005年3月行永久性人工心脏起搏器植入的患者共310例,其中植入心室抑制型(VVI)起搏器78例,双腔(DDD)起搏器164例,心室抑制型频率应答(VVIR)起搏器16例,双腔频率应答型(DDDR)起搏器52例.术后平均随访时间(36±1.8)个月,随访内容包括患者症状及生活质量、运动耐量、心功能.结果:除去由于房颤伴心室率过缓或长间歇而仅可植入单腔起搏器的患者外,本组病例DDD(R)起搏器植入率达82.4%.DDD起搏器(生理性起搏器)植入术后患者脑血管缺血症状全部消失,心功能不全明显改善,运动耐量也明显提高,无起搏器综合征、起搏器介导的心动过速的发生.非生理性起搏器植入术后脑缺血症状消失率为84.2%,心功能不全发生率明显高于生理性起搏组,12.3%的患者有起搏器综合征.结论:植入生理性心脏起搏器能改善患者心功能,提高生活质量,起搏器综合征发生率低,值得推荐.

Objective To observe the effect of physiological pacing on bradycardiac,cardiac function and improvement of quality of life.Method Retrospetive study was made to analyse 310 pacemakers including VVI 78 cases,DDD 164 cases,VVIR 16 cases,DDDR 52 cases from August 1999 to Spring 2005.The mean following time was(36±1.8) months.During the period,we explored the symptom,living quality,excise capability,cardiac function.Results Except for the patients having atrial fibrillation with bradycardia or long duration,82.4 percentage of the patients had implanted dual chambers pacemaker.After implanted the physiological pacemakers,the cerebral ischemic symptoms of the patients including amaurosis,syncope,swirl and so on disappeared,cardiac dysfunction and the exercise capacity improved.No pacing syndrome and no pacemaker intervened tachycardia was observed.Compared with the patients of implanted the physiological pacemakers,84.2 percentage of the patients resolved no cerebral ischemic symptoms,and the occurrence of cardiac dysfunction was higher than the formers.Conclusion Physiological pacing could improve cardiac function and living quality and decrease the occurrence of para atrial fibrillation and pacing syndrome,which is superior to unphysiological pacing.We should advocate physiological pacing.

参考文献:

[1] NIELSEN J C, ANDERSEN H R, BLOCH P E. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. 1998
[2] CAPYCCI A, ROMANO S, PUGLISI A. Dual chamber pacing with optimal AV delay in congestive heart failure:a randomized study. 1999(7). doi:10.1053/eupc.1999.0034
[3] SWEENEY M O, HELLKAMP A S, ELLENBOGEN K A. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. 2003. doi:10.1161/01.CIR.0000072769.17295.B1
[4] LAMAS G A, OVAN E J, STAMBER B S. Quality of life and dimical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. 1998. doi:10.1056/NEJM199804163381602
[5] SANFILIPPO A J, ABASCIAL V M, SHEECHAN M. Atrial enlargement as a consequence of atrial fibrillation:a prospective echocardiographic study, 1990

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