论文部分内容阅读
目的:探讨右室间隔部起搏患者起搏QRS波时限与心功能的关系。方法:回顾性分析植入右室间隔部起搏的双腔起搏器患者(111例),起搏器平均植入时间(4.52±3.65)年,通过常规体表心电图测得完全起搏时QRS波时限分为四组:A组为QRS≤120ms(21例);B组为120ms180ms(26例),行心脏彩色多普勒检查获取左房内径(LAD)、收缩末期左室内径(LVESD)、舒张末期左室内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及LVEF,同时检测患者的血清氨基末端脑肭肽前体(NT-proBNP),分析起搏QRS波时限与以上各指标的关系。结果:D组患者LAD、LVEDD、LVESD、IVST及IVPWT较其他三组明显增大,同时LVEF显著下降,NT-proBNP明显升高,有统计学意义(P<0.05)。同时发现随起搏QRS时限的不断增宽,不同组别的LVEF是依次降低(中位值分别为66.5%、60.3%、52.7%和45.8%),而血清NT-proBNP水平是依次增大(中位值分别为143.7 pg/ml、261.8 pg/ml、599.4 pg/m和971.2 pg/ml)。直线相关性分析示起搏QRS波时限与LAD(r=0.141,P<0.05)、LVEDd(r=0.678,P<0.05)、LVEDs(r=0.439,P<0.05)、IVST(r=0.165,P<0.05)及LVPWT(r=0.189,P<0.05)有显著线性关系,呈正相关。起搏QRS波时限与LVEF负相关(r=-0.684,P<0.05),起搏QRS波时限与NT-proBNP的对数正相关(r=0.368,P=0.029)。结论:对于右室间隔部起搏的双腔起搏患者,起搏QRS波时限是一个可初步判断心脏结构和功能的指标,其起搏QRS波时限延长可能会恶化患者的心脏结构及功能,可结合NT-proBNP进行动态观察,对起搏器植入患者的心功能恶化和心衰的预防有一定的临床实用价值。
Objective: To investigate the relationship between pacing QRS duration and cardiac function in patients with right ventricular septal pacing. Methods: A retrospective analysis of 111 patients with double-chamber pacemaker implanted in right ventricular septal pacing and mean implantation time of pacemaker (4.52 ± 3.65) years were performed. The total pacing was measured by routine surface electrocardiogram QRS wave duration was divided into four groups: group A QRS ≤ 120ms (21 cases); group B 120ms (LAD), end systolic left ventricular diameter (LVESD), left ventricular end diastolic dimension (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall (LVPWT) and LVEF were measured. Serum amino-terminal NT-proBNP was also detected in patients. The relationship between the pacemaker QRS wave duration and the above indexes was analyzed. Results: LAD, LVEDD, LVESD, IVST and IVPWT in group D were significantly increased compared with the other three groups. LVEF was significantly decreased and NT-proBNP was significantly increased in group D (P <0.05). At the same time, it was found that LVEF was decreased in turn (median, 66.5%, 60.3%, 52.7% and 45.8%, respectively) with increasing duration of QRS duration of pacing, while serum NT-proBNP level increased Median values were 143.7 pg / ml, 261.8 pg / ml, 599.4 pg / m and 971.2 pg / ml, respectively). Linear correlation analysis showed that QRS duration of pacing was significantly correlated with LAD (r = 0.141, P <0.05), LVEDd (r = 0.678, P <0.05), LVEDs P <0.05) and LVPWT (r = 0.189, P <0.05). There was a significant positive correlation between them. The QRS duration of pacing was negatively correlated with LVEF (r = -0.684, P <0.05). The QRS duration of pacing was positively correlated with the logarithm of NT-proBNP (r = 0.368, P = 0.029). Conclusions: For patients with pacing of right ventricular septum in dual-chamber pacing, QRS duration of pacing is an initial indicator of cardiac structure and function. Prolonged QRS duration of pacing may worsen the cardiac structure and function of patients, Can be combined with NT-proBNP for dynamic observation, implanted in patients with cardiac pacemaker impaired cardiac function and prevention of heart failure has some clinical value.