摘要:
目的 比较超声心动图指导下优化房室间期与经验性优化房室间期对心功能的影响。 方法 研究对象：2014年5 -12月在我院行双腔起搏器置入的患者66例。随机分为A、B两组，A组术后1周先给予经验性程控房室间期，B组术后1周先应用超声心动图指导优化房室间期。术后3个月时评估纽约心功能分级(New York Heart Association functional class，NYHA)，6 min步行距离实验(6-minute walk distance test，6MWT)。进行心脏超声检查，测量左心室射血分数(left ventricular ejection fraction，LVEF)、左心室舒张末内径(left ventricular end-diastolic diameter，LVEDD)、主动脉瓣口速度时间积分(velocity time integral，VTI)等。检验脑钠肽前体(pro-brain natriuretic peptide，Pro-BNP)水平等综合评价心功能，互换两组程控方法。术后6个月再次随访，观察心功能各项指标。进行自身前后配对比较两种程控方法对心功能的影响。 结果 两种程控方法对患者起搏比例无影响。A组6个月时LVEF、VTI、6MWT、Pro-BNP等心功能指标优于3个月时[LVEF (56.2±3.3)% vs (60.7±4.3)%，P=0.038；VTI (22.6±4.5) cm vs (25.1±4.6) cm，P=0.027；6MWT (327.4±128.6) m vs (396.5±115.1) m，P=0.015；Pro-BNP (298.6±198.6) pg/ml vs (118.3±156.4) pg/ml，P=0.028]。B组3个月时LVEF、VTI、6MWT、Pro-BNP等心功能指标优于6个月时[LVEF (59.2±5.6) vs (58.2±4.2)，P=0.024；VTI (25.2±4.9) cm vs (23.1±3.9) cm，P=0.014；6MWT (379.8±108.7) m vs (364.8±113.7) m，P=0.039；Pro-BNP (187.5±157.6) pg/ml vs (243.4±186.9) pg/ml，P=0.014]。两组NYHA和LVEDD无明显改变。 结论 超声心动图指导下优化房室间期有助于维护心功能，超声心动图可作为双腔起搏器优化房室间期的有效指导手段。
Abstract:
Objective To evaluate the instructive role of echocardiography in atrioventricular optimization compared with experienced optimization. Methods Sixty-six patients who were implanted with dual chamber pacemaker in our hospital from May 2014 to December 2014 were enrolled in this study and they were randomly divided into two groups. One week after operation, atrioventricular interval was programmed with experience in group A. At the same time, we used echocardiography to optimize the atrioventricular interval in group B. The first follow-up began at 3 months after implantation, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), aortic valve velocity time integral (VTI), pro-brain natriuretic peptide (Pro-BNP), 6-minute walk distance test (6MWT), New York Heart Association functional class (NYHA) were evaluated and then programmable methods of the atrioventricular interval were exchanged. Another 3 months later, the second follow-up came. The cardiac function was tested again. Then we evaluated the differences between the two methods. Results No difference was found in the proportion of ventricular pacing. In group A, the cardiac function index at 6 months was better than that at 3 months with significant differences [LVEF (56.2±3.3)% vs (60.7±4.3)%, P=0.038; VTI (22.6±4.5) cm vs (25.1±4.6) cm, P=0.027; 6MWT (327.4±128.6) m vs (396.5±115.1) m, P=0.015; Pro-BNP (298.6±198.6) pg/ml vs (118.3±156.4) pg/ml, P=0.028]. In group B, the cardiac function index at 3 months was preferable to that at 6 months with significant differences [LVEF (59.2±5.6)% vs (58.2±4.2)%, P=0.024; VTI (25.2±4.9) cm vs (23.1±3.9) cm, P=0.014; 6MWT (379.8±108.7) m vs (364.8±113.7) m, P=0.039; Pro-BNP (187.5±157.6) pg/ ml vs (243.4±186.9) pg/ml, P=0.014]. NYHA and LVEDD were not changed obviously in two groups. Conclusion Atrioventricular optimization with echocardiography helps maintain heart function. Furthermore, echocardiography can be an effective instructive method to optimize the atrioventricular interval of dual pacemaker.
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