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目的:运用超声心动图(ultrasonic cardiogram,UCG)评价右室心尖部(right ventricular apical,RVA)起搏及右室间隔部(right ventricular septal,RVS)起搏对完全性房室传导阻滞患者左室、左房收缩功能的影响,并观察两组患者的血浆脑钠肽(brain natriuretic peptide,BNP)水平的变化,研究植入埋藏式心脏起搏器术后左室收缩功能与血浆BNP之间是否具有相关性。方法:将具备埋藏式心脏起搏器植入适应证的51例完全性房室传导阻滞患者随机分为RVA起搏组(RVA组,20例)和RVS起搏组(RVS组,31例),分别于术前、术后1、3、6及12个月采用二维超声心动图Simpson法测定所有患者的左室射血分数(ejection fraction of left ventricle,LVEF)及左房射血分数(ejection fraction of left atrial,LAEF),同时测定患者血浆BNP值。结果:两组LVEF术后12个月较术前、术后1个月、术后3个月有所恢复(P<0.01);两组LAEF术后6个月、12个月较术前、术后1个月、术后3个月有所恢复(P<0.01);RVS组术后6个月、12个月LAEF恢复程度优于RVA组(P<0.01);RVS组术后12个月LVEF恢复程度优于RVA组(P<0.01)。所有患者LVEF与BNP水平呈负相关(r=-0.51,P<0.05)。RVS组术后BNP水平低于RVA组(P<0.01),RVS组术前、术后BNP水平不同时间点之间有差异(P<0.01)。结论:RVS起搏较RVA起搏更有利于左室及左房射血功能恢复,可能是更为理想的右室起搏部位。血浆BNP水平与LVEF具有相关性,可在一定程度上反映心脏起搏器安置术后患者左室收缩功能的恢复情况。
OBJECTIVE: To evaluate the effect of right ventricular apical (RVA) pacing and right ventricular septal (RVS) pacing on left aortic valve in patients with complete atrioventricular block Left ventricular systolic function and left ventricular systolic function were observed. The changes of plasma brain natriuretic peptide (BNP) level in both groups were observed to investigate the relationship between left ventricular systolic function and plasma BNP after implantation of buried cardiac pacemaker Is it relevant? Methods: Fifty-one patients with complete atrioventricular block with implantable pacemaker implantation were randomly divided into RVA group (n = 20) and RVS group (n = 31) ). Left ventricular ejection fraction (LVEF) and ejection fraction of left ventricle (LVEF) were measured in all patients by two-dimensional echocardiography Simpson at preoperative, postoperative 1, 3, 6 and 12 months (ejection fraction of left atrial, LAEF), while measuring plasma BNP values. Results: LVEF in both groups recovered at 12 months after operation compared with that before operation, one month after operation and three months after operation (P <0.01) The recovery of LAEF in RVS group was better than that in RVA group at 6 months and 12 months after operation (P <0.01) Month LVEF recovery is better than RVA group (P <0.01). All patients had a negative correlation between LVEF and BNP (r = -0.51, P <0.05). The level of BNP in RVS group was lower than that in RVA group (P <0.01), while the level of BNP in RVS group was different at different time points (P <0.01). Conclusion: Compared with RVA pacing, RVS pacing is more conducive to left ventricular and left atrial ejection function recovery, may be a more ideal right ventricular pacing site. Plasma BNP levels and LVEF have correlation, to some extent, reflect the recovery of patients with left ventricular systolic function after cardiac pacemaker placement.