永久性心脏起搏器植入对心力衰竭的干预效果研究

目的　分析希浦系统起搏（HPCSP）对心力衰竭的干预效果。方法　选取2020年4月至2022年4月在商丘市第一人民医院接受治疗的80例心力衰竭患者,按随机数字表法分为参考组（40例）和HPCSP组（40例）。参考组男26例、女14例,年龄（55.31±5.62）岁,给予双心室起搏;HPCSP组男23例、女17例,年龄（54.78±5.57）岁,在常规治疗的基础上给予HPCSP。比较两组心功能［左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）］,血压［舒张压（DBP）、收缩压（SBP）］,心率（HR）,起搏参数（阻抗、阈值、感知）,QRS时限,生活质量［健康调查简表（SF-36）］及并发症发生情况。计量资料采用t检验,计数资料采用χ²检验。结果　两组术后LVEDD［（59.45±6.01）mm、（64.37±6.52）mm］、HR［（75.42±7.61）次/min、（80.64±8.15）次/min］均明显低于术前［（70.23±7.26）mm、（69.58±7.21）mm、（90.45±9.31）次/min、（89.38±9.14）次/min］（均P<0.05）;HPCSP组术后阻抗［（510.79±51.26）Ω］明显低于术前［（541.37±55.23）Ω］（P<0.05）,且与参考组比较,HPCSP组明显降低（P<0.05）;两组LVEF、LVESD、DBP、SBP及SF-36评分均明显升高（均P<0.05）,且与参考组比较,HPCSP组明显升高（均P<0.05）;两组手术前后阈值、感知比较差异均无统计学意义（均P>0.05）;与术前比较,两组术后QRS时限明显缩短（均P<0.05）,且与参考组比较,HPCSP组明显缩短（P<0.05）。HPCSP组术后并发症发生率为7.50%（3/40）,明显低于参考组27.50%（11/40）,差异有统计学意义（χ²=4.242,P=0.039）。结论　HPCSP用于心力衰竭患者可有效保证心室同步收缩,提高生活质量,安全有效。

Study on intervention effect of permanent pacemaker implantation forheart failure

Objective　To analyze the intervention effect of His-Purkinje conductive systempacing (HPCSP) for heart failure. Methods　Eighty patients withheart failure treated in Shangqiu First People's Hospital from April 2020 toApril 2022 were gathered and were grouped into a reference group (40 cases) anda HPCSP group (40 cases) by the random number table. There were 26 males and 14females in the reference group, with an age of (55.31±5.62) years old; therewere 23 males and 17 females in the HPCSP group, with an age of (54.78±5.57)years old. The reference group was given biventricular pacing, and the HPCSPgroup was given HPCSP on the basis of conventional treatment. The cardiacfunction [left ventricular end-systolic diameter (LVESD), left ventricularend-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF)],blood pressure [diastolic blood pressure (DBP) and systolic blood pressure(SBP)], heart rate (HR), pacing parameters (impedance, output, and sense), QRSduration, quality of life [Shot Form 36 Health Survey (SF-36)], andcomplications were compared between the two groups. t test was used for the measurement data, and chi-square test wasused for the count data. Results　The LVEDD[(59.45±6.01) mm and (64.37±6.52) mm] and HR [(75.42±7.61) beats/min and(80.64±8.15) beats/min] in both groups after operation were significantly lowerthan those before operation [(70.23±7.26) mm, (69.58±7.21) mm, (90.45±9.31)beats/min, and (89.38±9.14) beats/min] (all P<0.05).The impedance of the HPCSP group after operation was significantly lower thanthat before operation [(510.79±51.26) Ω vs. (541.37±55.23) Ω] (P<0.05), and compared with that inthe reference group, the impedance of the HPCSP group was significantly lower (P<0.05). The LVEF, LVESD, DBP, SBP,and SF-36 score in the two groups were significantly increased (all P<0.05), and compared with those inthe reference group, those in the HPCSP group were significantly increased (all P<0.05). There were nostatistically significant differences in the output and sense between the twogroups before and after operation (all P>0.05).The QRS duration in the two groups after operation were significantly shorterthat those before operation (both P<0.05),and compared with that in the reference group, the QRS duration in the HPCSPgroup was significantly shorter (P<0.05).The incidence of postoperative complications in the HPCSP group was 7.50%(3/40), which was significantly lower than that in the reference group [27.50%(11/40)], with a statistically significant difference (χ²=4.242, P=0.039). Conclusion　HPCSP can effectivelyensure synchronous ventricular contraction in patients with heart failure, andimprove their quality of life, which is safe and effective.