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目的探讨术前血浆高同型半胱氨酸对右心室心尖部起搏患者左心室收缩功能的影响。方法病态窦房结综合征致Ⅲ度房室传导阻滞行植入双腔全自动心脏永久起搏器或单腔同步型起搏器患者100例,术前检测血浆同型半胱氨酸(homocysteine,Hcy)水平,按Hcy水平不同将患者分为观察组60例(Hcy≥10μmol/L)和对照组40例(Hcy<10μmol/L)。观察2组术后7d及术后1a时左室射血分数(left ventricular ejection fraction,LVEF)、起搏器心律心电图QRS波群时限(pacemaker rhythm electrocardiogram QRS duration,PQRSD)及血浆脑钠肽(brain natriuretic peptide,BNP)水平,记录术后1a心功能不全发生率。结果观察组术后即刻PQRSD[(131.52±6.24)ms]、血浆BNP[(107.15±25.10)ng/L]及术后7dLVEF[(49.60±7.30)%]与对照组[(133.40±7.66)ms、(73.88±12.09)ng/L、(51.80±7.90)%]比较差异均无统计学意义(P>0.05);术后1a观察组PQRSD[(139.15±7.30)ms]、血浆BNP[(343.95±40.42)ng/L]高于对照组[(134.63±6.70)ms、(202.85±52.03)ng/L],LVEF[(46.60±7.70)%]低于对照组[(49.60±7.00)%],2组比较差异均有统计学意义(P<0.015),心功能不全发生率(28%)高于对照组(13%)(P<0.05);术前高Hcy水平是术后左心室收缩功能不全的独立危险因素(OR=5.180,95%CI:1.977~17.087,P=0.001)。结论术前高血浆同型半胱氨酸可影响心脏起搏器右心室心尖部起搏患者左心室收缩功能,该指标可作为右心室起搏术后心脏结构与心功能变化评估指标。
Objective To investigate the effect of preoperative plasma homocysteine on left ventricular systolic function in patients with right ventricular apical pacing. Methods 100 cases of patients with Ⅲ degree atrioventricular block admitted with sick heart sinoatrial syndrome undergoing double-chamber automatic cardiac pacemaker or single-chamber synchronized pacemaker were enrolled. Preoperative plasma homocysteine (Hcy≥10μmol / L) and control group (Hcy <10μmol / L) according to the level of Hcy. The left ventricular ejection fraction (LVEF), pacemaker rhythm electrocardiogram QRS duration (PQRSD) and plasma brain natriuretic peptide natriuretic peptide (BNP) levels were recorded and the incidence of cardiac dysfunction after operation was recorded. Results The postoperative PQRSD [(131.52 ± 6.24) ms], plasma BNP (107.15 ± 25.10) ng / L and postoperative LVEF [49.60 ± 7.30%] in the observation group were significantly higher than those in the control group [(133.40 ± 7.66) ms , (73.88 ± 12.09) ng / L, (51.80 ± 7.90)%], respectively. There was no significant difference in PQRSD [(139.15 ± 7.30) ms] and plasma BNP [(343.95 ± 7.30) ± (40.62) ng / L] was significantly higher than that of control group [(134.63 ± 6.70) ms, (202.85 ± 52.03) ng / L] and LVEF [(46.60 ± 7.70)%] (P <0.015), the incidence of cardiac dysfunction (28%) was higher than that of the control group (13%) (P <0.05). The preoperative high level of Hcy was the difference of postoperative left ventricular systolic pressure Independent risk factors for impaired function (OR = 5.180, 95% CI: 1.977-17.087, P = 0.001). Conclusions Preoperative high plasma homocysteine can affect left ventricular systolic function in patients with right ventricular apical pacing in pacemakers. This index can be used as an index to evaluate changes in cardiac structure and cardiac function after right ventricular pacing.