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目的探讨影响双腔心脏起搏器(PM)寿命的有关因素,为双腔PM的合理应用和设计提供临床依据。方法自1991年始,对使用双腔PM的71例患者进行随访观察。从患者安装PM起,即对每例PM的感知电流、起搏电压和阻抗等有关起搏参数进行定期观察记录。到2005年观察终点,按照患者性别、年龄、诊断以及PM每种起搏参数的不同数值分别进行分组,对可能影响双腔PM寿命的有关参数进行统计学处理。结果双腔PM的平均使用寿命为111个月±19个月。单因素统计分析显示:患者基础心率、电池容量、起搏电压、起搏频率、阻抗、阈值、脉宽和感知电流对PM的寿命均有影响(均P<0.05)。Cox比例风险回归分析显示:感知电流[P=0.000,相对危险度(RR)=3.072,95%可信区间(CI)=2.130～4.429],起搏电压(P=0.040;RR=2.121,95%CI=1.126～3.998),阻抗(P=0.049,RR=1.786,95%CI=1.007～3.169)为重要的PM寿命预测指标。结论感知电流、起搏电压和阻抗是影响双腔PM寿命的重要因素,患者基础心率、电池容量、阈值、起搏频率和脉宽对双腔PM的使用寿命也有不同程度的影响。
Objective To explore the influencing factors of the life span of double chamber pacemaker (PM) and provide the clinical basis for the rational application and design of double chamber PM. Methods Since 1991, 71 patients with dual-chamber PM were followed up. From the patient’s installation of PM, that is, each case of PM sense current, pacing voltage and impedance and other related pacing parameters were regularly observed and recorded. By the end of 2005, the patients were grouped according to their gender, age, diagnosis and different values of each pacing parameter of PM, and the relevant parameters that may affect the PM dual-chamber life were statistically analyzed. Results The average lifetime of dual-chamber PM was 111 months ± 19 months. Univariate statistical analysis showed that the patients’ basal heart rate, battery capacity, pacing voltage, pacing frequency, impedance, threshold, pulse width and sensing current had an impact on the life of PM (all P <0.05). Cox proportional hazards regression analysis showed that the values of pacing current (P = 0.000, relative risk (RR) = 3.072, 95% confidence interval (CI) = 2.130-4.429), pacing voltage (P = 0.040; RR = 2.121,95 % CI = 1.126 ~ 3.998). Impedance (P = 0.049, RR = 1.786, 95% CI = 1.007-3.169) was an important predictor of PM lifetime. CONCLUSION: Current sensing, pacing voltage and impedance are two important factors affecting the lifetime of dual-cavity PM. The patients’ basal heart rate, battery capacity, threshold, pacing frequency and pulse width have different effects on the service life of dual-cavity PM.