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目的:观察右心室起搏QRS波时限对起搏器依赖患者心脏功能的影响。方法:选取在我院诊断为Ⅲ度房室传导阻滞并行永久性右心室起搏的患者112例,以起搏QRS波时限将患者分为A组(起搏QRS波时限<190ms)和B组(起搏QRS波时限≥190ms),并对每例患者进行临床评估和心脏彩色多普勒超声检查,动态随访心脏功能,以随访期间出现明显心功能下降为终点,观察起搏QRS波时限与心脏功能的关系。同时根据随访期间是否出现心功能下降将患者分为心功能下降组(Y组)和心功能无下降组(N组),并进行各因素与心功能下降之间的单因素分析,取P<0.1的因素纳入Logistic回归模型,寻找影响起搏器依赖患者心功能的因素。结果:平均随访(45.46±23.00)个月,40例(28.57%)出现明显心功能下降,其中,A组24例(27.27%),B组16例(66.67%),2组间差异有统计学意义(P=0.0004),Y组的起搏QRS波时限较N组明显延长[(176.58±22.71)∶(159.74±20.23)ms,P<0.0001]。多元Logistic逐步回归分析结果显示,左心室舒张末期内径增大、射血分数下降、左束支传导阻滞、起搏QRS波时限≥190ms、年龄及起搏时间是起搏器依赖患者心功能下降的危险因素。结论:起搏QRS波时限延长是心脏功能下降和心力衰竭发生的危险因素,可以作为起搏器依赖患者起搏后心脏功能下降的预测指标。除此之外,左心室增大、左束支传导阻滞、射血分数降低、年龄及起搏时间也是起搏器依赖患者心脏功能下降的危险因素。
Objective: To observe the effects of right ventricular pacing QRS wave duration on cardiac function in patients with pacemaker dependence. Methods: One hundred and twelve patients with third-degree atrioventricular block and permanent right ventricular pacing diagnosed in our hospital were selected. The patients were divided into group A (QRS wave duration of pacing <190ms) and B Group (pacing QRS wave duration ≥190ms), and clinical evaluation and cardiac color Doppler echocardiography were performed in each patient. Cardiac function was dynamically followed up. During the follow-up period, significant cardiac function was decreased as the end point. Relationship with heart function. At the same time, patients were divided into two groups according to whether there was a decline in cardiac function during the follow-up: group Y (group Y) and group D (group N), and univariate analysis between each factor and heart function. P < 0.1 factor into the Logistic regression model to find the factors that affect cardiac function in patients with pacemaker dependent. Results: The average follow-up (45.46 ± 23.00) months, 40 patients (28.57%) showed significant decline in cardiac function, of which 24 cases (27.27%) in group A and 16 cases (66.67%) in group B, (P = 0.0004), the duration of pacing QRS in group Y was significantly longer than that in group N [(176.58 ± 22.71): (159.74 ± 20.23) ms, P <0.0001]. Multivariate Logistic stepwise regression analysis showed that left ventricular end-diastolic diameter increased, ejection fraction decreased, left bundle branch block, pacing QRS wave duration of ≥ 190ms, age and pacing time was decreased cardiac pacemaker-dependent patients Risk factors. CONCLUSIONS: Pacemaker prolongation of QRS duration is a risk factor for decreased cardiac function and heart failure and may be used as a predictor of cardiac function decline after pacing in pacemaker-dependent patients. In addition, left ventricular enlargement, left bundle branch block, decreased ejection fraction, age and pacing time are also risk factors for impaired cardiac function in patients with pacemakers.