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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
任璐,李兴剑,罗伟刚.非心脏手术中临时起搏器植入后的起搏比例对心功能的影响[J].中华老年多器官疾病杂志,2018,17(9):672~676
非心脏手术中临时起搏器植入后的起搏比例对心功能的影响
Frequency of pacing by temporary pacemaker and its effects on the cardiac function in the non-cardiac surgery
投稿时间:2018-03-06  修订日期:2018-05-11
DOI:10.11915/j.issn.1671-5403.2018.09.154
中文关键词:  心脏起搏器;心脏功能;起搏比例
英文关键词:pacemaker; cardiac function; frequency of pacing
基金项目:
作者单位E-mail
任璐 宝鸡市中心医院心血管内科,宝鸡721008  
李兴剑 宝鸡市中心医院心血管内科,宝鸡721008  
罗伟刚 宝鸡市中心医院心血管内科,宝鸡721008 renluyxtg@163.com 
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中文摘要:
      目的 探讨非心脏手术中临时起搏器(TPM)植入后的起搏比例对心功能的影响。方法 回顾性分析2012年6月至2017年6月宝鸡市中心医院心血管内科非心脏手术中植入TPM患者200例,依据右心室起搏比例分为高搏组128例和低搏组72例,比较2组患者并发症、术前和术后1 d 心率(HR)、心脏指数(CI)、左心室射血分数(LVEF)、肌酸激酶同工酶MB(CKMB)、肌钙蛋白T(TnT)、氨基末端脑钠肽前体(NT-proBNP)以及房颤发生率。采用SPSS 22.0统计软件对数据进行分析。组间比较采用t检验、方差分析、χ2检验或Z检验。结果 高搏组和低搏组患者手术并发症发生率分别为4.69%(6/128)和6.94%(5/72),差异无统计学意义(P>0.05)。高搏组患者术后1 d相比术前HR、CI和LVEF水平降低,CKMB、TnT和NT-proBNP水平升高,差异有统计学意义(P<0.05)。高搏组患者术后1 d相比低搏组患者HR[(62.47±6.51) vs(69.43±7.24)beats/min]、CI[(2.45±0.30) vs(3.86±0.42)L/(min·m2)]和LVEF[(35.12±3.55)% vs(39.94±4.11)%]水平降低,CKMB[(46.87±5.43) vs(38.32±4.16)U/L]、TnT[(86.45±9.05) vs(68.02±7.36)ng/L]和NT-proBNP[(275.12±30.24) vs(228.31±29.57)ng/L]水平升高,差异具有统计学意义(P<0.05)。高搏组新发房颤发生率为7.81%(10/128),低搏组无新发房颤发生,差异有统计学意义(χ2=4.391,P=0.045)。结论 非心脏手术中植入TPM后≤50%起搏比例可有效保持患者心功能稳定,有利于避免术后新发房颤的发生。
英文摘要:
      Objective To investigate frequency of pacing by temporary pacemaker and its effects on the cardiac function in the non-cardiac surgeries. Methods A total of 200 patients were selected who had undergone non-cardiac surgeries with TPM in Baoji Central Hospital from June 2012 to June 2017. Based on the frequency of right ventricular pacing (RVP), all the patients were divided into high-pacing group (>50%, n=128) and low-pacing group (≤50%, n=72). The two groups were then compared in complications, heart rate (HR) 1 day pre- and post-operatively, cardiac index (CI), left ventricular ejection fraction (LVEF), creatine kinase isoenzyme MB (CKMB), troponin T (TnT), amino-terminal pro-brain natriuretic peptide (NT-proBNP) and atrial fibrillation. SPSS statistics 22.0 was used for data analysis, and Student′s t test, ANOVA, Chi-square test or Z test for comparison. Results The incidence of complications was 4.69% (6/128) in the high-pacing group against 6.94%(5/72) in the low-pacing group, with no significant difference between the two groups (P>0.05). The levels of HR, CI and LVEF were significantly lower 1 day postoperatively than preoperatively, and the levels of TnT and NT-proBNP were significantly higher 1 day postoperatively in the high-pacing group than in the low-pacing group (P<0.05). Compared with the low-pacing group, the high-pacing group had lower HR[(62.47±6.51) vs (69.43±7.24)beats/min], CI[(2.45±0.30) vs (3.86±0.42)L/(min·m2)], and LVEF[(35.12±3.55)% vs (39.94±4.11)%], but higher CKMB[(46.87±5.43) vs (38.32±4.16)U/L], TnT[(86.45±9.05) vs (68.02±7.36)ng/L]and NT-proBNP[(275.12±30.24) vs (228.31±29.57)ng/L](P<0.05). An incidence of new atrial fibrillation of 7.81%(10/128) in the high-pacing group was significantly higher than that of 0.00% (0/72) in the low-pacing group(χ2=4.391, P=0.045). Conclusions Low frequency of pacing (≤50%) by TPM can effectively maintain stable cardiac function in the patients undergoing non-cardiac surgery, helping to avoid the occurrence of postoperative new-onset atrial fibrillation.
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