2024 年第 4 期 第 19 卷

双腔心脏起搏器术后心力衰竭发生的影响因素分析

Analysis of the influencing factors on the occurrence of heart failure after dual chamber pacemaker implantation

作者：格日勒郭欣君赵平滕菲刘鸿亚许利冬

英文作者：Gerile Guo Xinjun Zhao Ping Teng Fei Liu Hongya Xu Lidong

单位：内蒙古自治区人民医院心脏中心心血管内科，呼和浩特010017

英文单位：Department of Cardiac Center Cardiouascular Medicine Inner Mongolia Autonomous Region People′s Hospital Hohhot 010017 China

关键词：双腔心脏起搏器；心力衰竭；影响因素

英文关键词：Dualchamberpacemaker；Heartfailure；Influencingfactors

• 摘要：

• 目的 分析双腔心脏起搏器术后心力衰竭发生的影响因素。方法 选取2020年4月至2021年10月于内蒙古自治区人民医院心血管内科首次安装永久性心房心室双感知双起搏双反应型(DDD)起搏器且心室起搏比例＞40%的100例患者作为研究对象。患者分别在术前和术后3、6个月检测超声心动图、心电图、动态心电图、N末端B型脑钠肽前体（NT-proBNP）、6 min步行试验（6MWT）距离，并在随访结束后检测心功能参数。建立多因素Logistic回归模型，分析患者术后发生心力衰竭的影响因素。结果 与术前比较，术后6个月患者QRS时限、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、NT-proBNP较高，左心室射血分数（LVEF）较低，6MWT距离较短（均P＜0.05）。术后6个月100例患者中41例发生心力衰竭。与无心力衰竭组比较，心力衰竭组QRS时限、左心房内径、LVESD、LVEDD、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）、NT-proBNP较高［（156±10）ms比（113±11）ms、（39.1±2.1）mm比（37.2±1.8）mm、（34±4）mm比（33±4）mm、（50±9）mm比（47±4）mm、（46±6）ml比（42±4）ml、（109±7）ml比（106±7）ml、（811±208）ng/L比（588±210）ng/L］，LVEF较低［（48±4）%比（59±4）%］，6MWT距离较短［（366±54）m比（538±58）m］（均P＜0.05）。多因素Logistic回归分析结果显示，年龄、QRS时限、LVESV、LVEDV、LVEF、NT-proBNP、6MWT距离是患者术后发生心力衰竭的独立危险因素（均P＜0.05）。结论 年龄以及NT-proBNP、6MWT距离等心功能参数均与DDD起搏器术后心力衰竭发生密切相关。

• Objective To analyze the influencing factors on the occurrence of heart failure after dual chamber pacemaker implantation. Methods A total of 100 patients who were installed permanent atrial and ventricular dual sensing dual pacing dual response (DDD) pacemaker for the first time in the Department of Cardiovascular Medicine, Inner Mongolia Autonomous Region People′s Hospital from April 2020 to October 2021 were selected as the research objects, and the proportion of ventricular pacing was more than 40%. Echocardiography, electrocardiogram, dynamic electrocardiogram, N-terminal pro-brain natriuretic peptide (NT-proBNP) and 6 min walking test (6MWT) distance were measured before operation and 3 and 6 months after operation. After the follow-up, cardiac function parameters of patients were detected. Multivariate Logistic regression model was established to analyze the influencing factors of postoperative heart failure. Results The QRS duration, left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD) and NT-proBNP were significantly higher, left ventricular ejection fraction (LVEF) was significantly lower, and 6MWT distance was significantly shorter at 6 months after operation than those before operation (all P＜0.05). After 6 months of follow-up, a total of 41 patients with heart failure were found in 100 patients. The QRS duration, left atrial diameter, LVESD, LVEDD, left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV) and NT-proBNP in the heart failure group were higher than those in the non-heart failure group［(156±10)ms vs (113±11)ms, (39.1±2.1)mm vs (37.2±1.8)mm, (34±4)mm vs (33±4)mm, (50±9)mm vs (47±4)mm, (46±6)ml vs (42±4)ml, (109±7)ml vs (106±7)ml, (811±208)ng/L vs (588±210)ng/L］, the LVEF in the heart failure group was lower than that in the non-heart failure group［(48±4)% vs (59±4)%］, and the 6MWT distance in the heart failure group was shorter than that in the non-heart failure group［(366±54)m vs (538±58)m］(all P＜0.05). Multivariate Logistic regression analysis showed that age, QRS duration, LVESV, LVEDV, LVEF, NT-proBNP and 6MWT distance were independent risk factors for postoperative heart failure in patients (all P＜0.05). Conclusion Age, NT-proBNP, 6MWT distance and other cardiac function parameters were closely related to the occurrence of heart failure after DDD pacemaker implantation.