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目的探讨右室流入道间隔部(RVIS)和右室心尖部(RVA)起搏,治疗缓慢性心律失常神经内分泌激素和心功能的变化。方法 106例行DDD起搏器治疗的患者:男86例,女20例,年龄45～86岁,平均76岁,随机分为:右室流入道间隔部起搏组(RVIS起搏组)56例,右室心尖部起搏组(RVA起搏组)50例。2组心房电极均植入右心耳梳状肌内,RVIS起搏组心室电极植入右室流入道间隔部、RVA起搏组心室电极植入右室心尖部。分别观察2组在起搏器植入时、起搏3个月和6个月不同时期,血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、心钠肽(BNP)和去甲肾上腺素(NE)等神经内分泌激素的含量;用彩色多普勒超声心动图测定:心排血量(CO)、每搏输出量(SV)、射血分数(EF)、左室舒张末内径(LVDd)和左室短轴缩短分数(FS)。结果 RVA起搏组治疗后其神经内分泌激素和心功能,较起搏治疗前恶化,且随着起搏时间的延长趋于明显,而RVIS起搏组,其神经内分泌激素和心功能改变,较起搏治疗前明显改善,且随着起搏时间的延长改善的越明显,与RVA起搏组比较,具有统计学意义(P<0.05)。结论 RVIS起搏优于RVA起搏,可明显改善心功能,纠正神经内分泌激素失调,值得临床推广。
Objective To investigate the changes of neuroendocrine hormones and cardiac function in patients with bradyarrhythmia induced by right ventricular invaginal septum (RVIS) and right ventricular apex (RVA) pacing. Methods One hundred and sixty patients undergoing DDD pacemaker treatment were enrolled in this study: 86 males and 20 females, aged 45-86 years (average 76 years), were randomly divided into: right ventricular inflow septum pacing group (RVIS pacing group) Cases, right ventricular apical pacing group (RVA pacing group) 50 cases. The atrial electrodes of the two groups were implanted into the comb muscle of the right ear. The ventricular electrodes of the RVIS pacing group were implanted into the interventricular septum of the right ventricle, and the ventricular electrodes of the RVA pacing group were implanted into the apex of the right ventricle. The changes of plasma renin activity (PRA), angiotensin Ⅱ (AngⅡ), aldosterone (ALD), atrial natriuretic peptide (BNP) ), Norepinephrine (NE) and other neuroendocrine hormones were measured. Color Doppler echocardiography was used to determine cardiac output (CO), stroke volume (SV), ejection fraction Ventricular end-diastolic diameter (LVDd) and left ventricular fractional shortening fraction (FS). Results The neuroendocrine hormones and cardiac function in RVA pacing group were worse than those before pacing treatment and tended to be obvious with the prolongation of pacing time. Compared with the RVIS pacing group, the changes of neuroendocrine hormones and cardiac function were more significant Pacing improved significantly before treatment, and with the pacing time to improve the more obvious, compared with the RVA pacing group, with statistical significance (P <0.05). Conclusions RVIS pacing is superior to RVA pacing, which can significantly improve cardiac function and correct neuroendocrine hormone imbalance, which is worthy of clinical promotion.