高龄老年人右室心尖部及室间隔上部起搏对心功能的影响

【目的】探讨高龄老年人右室心尖部（RVA）和室间隔上部（RVUS）起搏对心功能的影响，寻找最佳起搏部位。【方法]89例行DDD起搏器治疗的患者：男84例，女5例，平均年龄84（75～95）岁，分为RVA组44例，RVUS组45例。对比分析两组起搏器间术前、术后3个月、6个月和1年心脏超声指标：心排血量（CO）、每搏输出量（sV）、射血分数（EF）、左室舒张末内径（LVDd）和血脑利钠肽（BNP）等的变化。【结果】RVA组治疗后心功能较起搏治疗前恶化，且随着起搏时间的延长恶化程度加重，而RVUS组心功能较起搏治疗前明显改善，且随着起搏时间的延长改善的越明显，与RVA组比较，具有统计学意义（P〈0．05）。【结论】高龄老年人RVUS优于RVA，可明显改善心功能，值得在高龄老年人中推广。

Effect of Right Ventricular Upper Septal Pacing and Right Ventricular Apical Pacing on Cardiac Function in Elderly Patients

Objective]To explore the effect of right ventricular upper septal（RVUS） pacing or right ventricular apical（RVA） pacing on cardiac function in elderly patients in order to find the best pacing position. {Methods]Eighty-nine elderly patients（84 males and 5 females, aged from 75 to 95 years old, mean 84 years old） treated with DDD pacemaker were randomly divided into RVA group（ n = 44） and RVUS group（ n = 45）. The changes of cardiac output（CO）, stroke volume（SV）, ejection fraction（EF）, left ventricular end diastolic diameter（LVDd） and serum brain natriuretic peptide（BNP） before operation and 3, 6 and 12 months after operation were compared between two groups. Results] In RVA group, heart function deteriorated com- pared with that before pacing, and became more serious with the increasing of pacing time. In RVUS group, heart function significantly improved compared with that before pacing, and became more obvious with the increasing of pacing time. There was significant difference in heart function between RVA group and RVUS group（ P 〈0.05）. Conclusion]RVUS for the elderly patients is better than RVA, and can significantly improve heart function, so it is worthy of being extended in elderly patients.