论文部分内容阅读
目的:探讨不同的起搏QRS波时限与N端-B型脑钠肽原(NT-proBNP)及左心功能间的关系。方法:将90例因Ⅲ度房室传导阻滞而植入心脏起搏器患者根据起搏的不同QRS波时限分成3组,即<160 ms组、160～180 ms组和>180 ms组。对3组患者术后1、3个月的血浆NT-proBNP、左心室射血分数(EF)、左心室舒张末期内径(LVEDD)变化与基线作比较,并进行多因素分析;以QRS波时限为自变量,术后3个月NT-proBNP、EF、LVEDD与术前的差值为因变量,进行多因素logistic回归分析。结果:起搏QRS波<160 ms组患者术后血浆NT-proBNP、EF、LVEDD变化与术前比较,无统计学差异(P>0.05);160～180 ms组患者术后1、3个月,其EF与基线相比,差异无统计学意义,而术后1、3个月的NT-proBNP与基线比较,差异有统计学(P<0.001);术后1个月的LVEDD与基线相比差异,无统计学意义,而术后3个月的LVEDD与基线相比差异有统计学意义(P<0.05);>180 ms组患者术后1、3个月的NT-proBNP、EF、LVEDD与基线相比,差异有统计学意义(P<0.001)。多因素分析结果提示,患者术后3个月的血浆NT-proBNP、EF、LVEDD水平与术前的差值与其QRS波时限密切相关(P均<0.001)。结论:过宽的起搏QRS波时限是起搏患者心功能恶化的预测因子。
Objective: To investigate the relationship between different pacing QRS wave duration and N-terminal B-type brain natriuretic peptide (NT-proBNP) and left ventricular function. METHODS: Ninety patients with pacemaker implanted with a third degree atrioventricular block were divided into three groups according to different pacing QRS wave durations: <160 ms, 160-180 ms, and> 180 ms. The changes of plasma NT-proBNP, left ventricular ejection fraction (EF) and left ventricular end-diastolic diameter (LVEDD) at 1, 3 months postoperatively were compared with those of the baseline and analyzed by multivariate analysis. As independent variables, 3-month postoperative NT-proBNP, EF, LVEDD and preoperative differences as dependent variables, multivariate logistic regression analysis. Results: The changes of postoperative plasma NT-proBNP, EF and LVEDD in patients with QRS wave less than 160 ms after pacing were not statistically different from those before operation (P> 0.05) (P <0.001). The LVEDD at 1 month after surgery was significantly lower than that at baseline (P <0.001). There was no significant difference in EF between baseline and baseline (P <0.05). The levels of NT-proBNP, EF, MMP-9 in the patients with> 180 ms after operation were significantly lower than those in patients with> LVEDD was significantly different from baseline (P <0.001). Multivariate analysis showed that the level of plasma NT-proBNP, EF and LVEDD at 3 months postoperatively correlated with the preoperative difference in QRS wave duration (all P <0.001). Conclusions: Too broad pacing QRS wave duration is a predictor of worsening cardiac function in patients with pacing.