摘要
目的比较右室流出道间隔部(RVS)与右室心尖部(RVA)起搏对心肌重构及血浆醛固酮(ALD)、血管紧张素Ⅱ(AngⅡ)水平的影响。方法60例具备起搏器植入指征的患者,随机分为RVA组与RVS组,分别于治疗前及治疗后6、12、24个月采血检测血浆ALD、AngⅡ水平;并测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF),观察2组患者起搏前后心室重构、心脏功能的变化。结果2组患者均顺利完成手术。RVA组起搏术后各个时间点ALD、AngⅡ水平显著升高,且明显高于RVS组(P<0.05);而RVS组起搏术后无明显变化,差异无统计学意义(P>0.05)。术后随访结果显示,RVA组随着起搏时间的延长,12、24个月时与术前比较,LVEDD、LVESD增大,LVEF下降,差异均有统计学意义(P<0.05);而RVS组LVEDD、LVESD无明显增大,LVEF呈下降趋势,但差异无统计学意义(P>0.05)。结论RVS起搏较RVA起搏能减轻神经内分泌激活,改善心肌重构,从而改善左室功能。
Objective To compare the effects of right ventricular outflow tract septal（RVS） pacing and right ventricular apical（RVA） pacing on cardiac remodeling,aldosterone（ALD） and angiotensinⅡ（AngⅡ）.Met hods Sixty patients with indication of pacemaker implantation were randomly divided into two groups,RVA group and RVS group.The level of ALD and AngⅡwas detected pre and 6m,12m,24m post therapy,and echocardiography examination was applied to measure and follow up the left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD） and left ventricular ejection fraction（LVEF）.Then the difference of cardiac remodeling and heart function in the two groups were observed and compared.Results All patients in two groups were successfully underwent pacemaker implantation.The level of ALD,AngⅡin RVA group increased significantly than pre operation,and it was obviously higher than those in RVS group（P〈0.05）.There was no significant change of ALD,AngⅡin RVS group（P〉0.05）.In the following time after operation,the LVEDD,LVESD increased, and LVEF decreased after 12 months and 24 months in RVA group,of which the difference has statistical significance（P〈0.05）.There was no significant difference of LVEDD,LVESD in RVS group,yet there was downtrend in LVEF,and difference did not show statistical significance（P〉0.05）.Conclusion Compared with RVA pacing,the RVS pacing was more beneficial to decline activation of nerve endocrine,to prevent cardiac remodeling and improve heart function.
出处
《疑难病杂志》
CAS
2010年第7期484-486,共3页
Chinese Journal of Difficult and Complicated Cases
关键词
心脏起搏
心室间隔部
右室心尖部
心肌重构
醛固酮
血管紧张素Ⅱ
Cardiac pacing
Right ventricular outflow tract septa
Right ventricular apical
Cardiac remodeling
Aldosterone
AngiotensinⅡ
