不同起搏部位对左心室重构及左心收缩功能的影响

目的 研究右室间隔起搏及传统右室心尖部起搏对左心室重构及左心收缩功能的影响。方法 收集2013年1月~2015年5月曾于亳州市人民医院心内科行双腔起搏器植入术且随访资料完整的患者共63例，其中右室间隔起搏组共32例，右室心尖部起搏组共31例，观察两组术前与术后1年左室舒张末容积、左室射血分数、及血清NT-proBNP水平变化。结果 两组起搏器植入术前血清NT-proBNP水平及左室舒张末期内径和左室射血分数比较，差异无统计学意义（P＞0.05），术后1年随访检测血清NT-proBNP水平，右室心尖部起搏组较右心室间隔部组升高（P＜0.05）；右心室间隔部起搏组术后左室舒张末期内径和左室射血分数与术前比较，差异无统计学意义（P＞0.05）；右室心尖部起搏组术后1年左室舒张末期内径较术前增大，左室射血分数减小（P＜0.05）。结论 相较于传统的右室心尖部起搏，右室间隔部起搏更能保证心室正常的电活动顺序，且对左室收缩功能的影响较小。

Effects of Different Pacing Sites on Left Ventricular Remodeling and Left Ventricular Systolic Function

Objective To investigate the effects of right ventricular septal pacing and traditional right ventricular apical pacing on left ventricular remodeling and left ventricular systolic function.Methods From January 2013 to May 2015, a total of 63 patients underwent double-chamber pacemaker implantation in Department of Cardiology, Bozhou people's Hospital, with complete follow-up data, including 32 cases in the right ventricular septal pacing group and 31 cases in the right ventricular apex pacing group. Left ventricular end-diastolic volume (LVEF), left ventricular ejection fraction (LVEF) and serum NT-proBNP level were observed before and 1 year after operation. Results There were no significant differences in serum NT-proBNP levels and left ventricular end-diastolic diameter and left ventricular ejection fraction between the two groups before pacemaker implantation (P>0.05). Serum NT-proBNP levels were measured at 1 year follow-up. The right ventricular apical pacing group was higher than the right ventricular septal group (P<0.05). The left ventricular end-diastolic diameter and left ventricular ejection fraction of the right ventricular septal pacing group were compared with those before surgery,The difference was not statistically significant(P>0.05). The left ventricular end-diastolic diameter of the right ventricular apical pacing group increased 1 month after operation, and the left ventricular ejection fraction decreased (P<0.05). Conclusion Compared with the traditional right ventricular apical pacing, right ventricular septal pacing can ensure the normal electrical activity sequence of the ventricle, and has little effect on the left ventricular systolic function.