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目的观察双腔起搏器最小心室化起搏功能与最佳房室间期优化对减少心室起搏和心功能的影响。方法30例符合标准患者入选。随机分为最小心室化起搏组(RVP,n=16)和超声优化下最佳房室间期组(OAV,n=14)。首先,分别在术后1周和术后6个月进行随访,术后6个月两组交叉(RVP转OAV,OAV转RVP),并于术后1年再次随访。随访中评估右室起搏比例、6 min步行试验、纽约心功能分级、明尼苏达州心力衰竭患者生活质量问卷和左室射血分数等指标。结果术后6个月随访,RVP较OAV组的右室起搏比例明显降低(P<0.05)。至术后1年随访时,OAV转RVP组的右室起搏比例较RVP转OAV组明显降低(P<0.05)。交叉前后的自身比较显示起搏器RVP功能打开后能显著降低右室起搏比例(P<0.05)。其他各项指标在两组间都无显著差异(P>0.05)。结论两种优化方式对于患者短期心功能无明显影响,但RVP较OAV能明显减少右室起搏比例。
Objective To observe the effect of minimizing ventricular pacing and optimal atrioventricular pacing in dual chamber pacemakers to reduce ventricular pacing and cardiac function. Methods Thirty patients were eligible. Randomly divided into the minimal ventricular pacing group (RVP, n = 16) and the best room under ultrasound wave group (OAV, n = 14). First, they were followed up 1 week after surgery and 6 months after surgery respectively. After 6 months, the two groups were crossed (RVP to OAV and OAV to RVP) and were followed up again one year after surgery. Follow-up assessment of right ventricular pacing ratio, 6 min walk test, New York Heart Function Scale, Minnesota Heart Failure Quality of Life Questionnaire and left ventricular ejection fraction and other indicators. Results After 6 months of follow-up, the RVP percentage in RVP group was significantly lower than that in OAV group (P <0.05). At 1-year follow-up, the percentage of right ventricular pacing in OAV-RVP group was significantly lower than that in RVP-OAV group (P <0.05). Comparison of their own before and after the crossover showed that the pacemaker RVP function can significantly reduce the right ventricular pacing rate (P <0.05). There was no significant difference in other indexes between the two groups (P> 0.05). Conclusion Both of the two optimization methods have no significant effect on short-term cardiac function, but RVP significantly reduces the ratio of right ventricular pacing compared with OAV.