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目的:通过比较右心室心尖部(RVA)和右心室中位间隔部(mid-RVS)两种不同部位起搏早期对患者血浆白细胞介素-6(IL-6)、血浆心房利钠肽(ANP)水平和左心功能的影响,探讨IL-6、ANP水平与无症状左心收缩功能(ALVD)不全的相关性。方法:将42例植入DDD型起搏器患者随机分为RVA起搏组、mid-RVS起搏组,观察两组患者起搏器植入术前及术后3个月和6个月血浆IL-6、ANP水平、左房内径(LAD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)以及心电图QRS波时限的变化。结果:术前和术后3个月比较,两组患者血浆IL-6、ANP水平和LAD、LVEDD、LVEF等均无明显差异;术后6个月RVA起搏组血浆IL-6、ANP水平和LAD、LVEDD较mid-RVS起搏组显著升高(P<0.01);RVA起搏组术后6个月与术前、术后3个月比较,IL-6、ANP水平和LAD、LVEDD等明显升高(P<0.05),LVEF有降低趋势。术后mid-RVS起搏组QRS波时限明显小于RVA起搏组(P<0.001)。结论:右室中间隔起搏有助于避免常规右室心尖部起搏导致的血浆IL-6和ANP水平增高以及左房、左室的扩大,可能减少心力衰竭的发生。
OBJECTIVE: To compare the effects of early pacing at different locations of right ventricular apex (RVA) and mid-RVS on plasma levels of interleukin-6 (IL-6), plasma atrial natriuretic peptide ANP levels and left ventricular function, explore the correlation between IL-6, ANP levels and asymptomatic left ventricular systolic function (ALVD) insufficiency. Methods: Forty-two patients with DDD implanted pacemaker were randomly divided into RVA pacing group and mid-RVS pacing group. Before and after 3 months and 6 months after implantation of pacemaker, plasma The levels of IL-6, ANP, LAD, LVEDD, LVEF and ECG QRS duration were measured. Results: The levels of plasma IL-6, ANP, LAD, LVEDD and LVEF were not significantly different between the two groups before and 3 months after operation. The levels of IL-6 and ANP in RVA pacing group (P <0.01). The levels of IL-6, ANP, LAD and LVEDD in the RVA pacing group at 6 months and 3 months after operation were significantly higher than those in the mid-RVS pacing group Were significantly higher (P <0.05), LVEF decreased. The postoperative QRS duration of mid-RVS pacing group was significantly shorter than that of RVA pacing group (P <0.001). Conclusions: Right ventricular septal pacing helps to prevent the increase of plasma IL-6 and ANP levels and the expansion of left atrium and left ventricle caused by conventional right ventricular apical pacing, which may reduce the incidence of heart failure.