标题：临时心脏起搏器植入术对Ⅲ度房室传导阻滞患者的心功能及BNP、cTnI等指标的影响

      作者：朱朝江，魏高辉    (重庆市九龙坡区第二人民医院心内科，重庆 400052)

      卷次： 2017年28卷3期

      【摘要】 目的 研究临时心脏起搏器植入术(TPI)对Ⅲ度房室传导阻滞(Ⅲ-DAB)患者的心功能及血浆脑钠肽(BNP)、血清心肌肌钙蛋白(cTnI)等指标的影响。方法 选择 2010年 5月至 2016年 5月在我院心内科接受TPI术式治疗的88例Ⅲ-DAB患者作为观察组，另选同期在医院进行健康体检的志愿者85例作为对照组，统计两组受检者的血浆BNP、血清cTnI，以及观察组TPI治疗前后的心功能指标，分析观察组各指标间的相关性及患者预后。结果 观察组患者的BNP (112.24±17.33) pg/mL及cTnI水平(1.28±0.26) ng/mL均明显高于对照组的(28.53±9.82) pg/mL及(0.03±0.02) ng/mL，差异有统计学意义(P<0.05)；观察组患者TPI治疗后的左室射血分数(LVEF)(69.27±6.33)%及心脏指数(CI)(4.18±0.13) L/min·m2，均明显高于 TPI治疗前的 (51.39±3.17)%及 (3.15±0.11) L/min·m2，左房内径 (LAD)(31.19±3.06) mm及左室舒张末期内径(LVEDD)(42.18±4.13) mm均明显低于 TPI治疗前的(43.58±5.21) mm及(50.26±5.30) mm，差异有统计学意义(P<0.05)；观察组患者经TPI治疗后的BNP (41.83±9.87) pg/mL及 cTnI水平(0.53±0.07) ng/mL均明显低于 TPI治疗前的(112.24±17.33) pg/mL及(1.28±0.26) ng/mL，差异有统计学意义(P<0.05)；根据 Spearman法分析相关性可知，观察组患者的血浆 BNP和血清 cTnI均分别与 LVEF及 CI呈负相关(r=-5.394、-7.108、-6.024、-6.138)，与LAD及LVEDD呈正相关(r=6.133、5.971、5.421、5.620)；观察组患者均经TPI治疗后一次植入成功，成功率为100%，治疗后并未出现明显的并发症。结论 利用TPI术式治疗Ⅲ-DAB患者具有较好的疗效及安全性，且患者的血浆BNP和血清cTnI与LVEF及CI呈负相关，与LAD及LVEDD呈正相关，值得临床重视。
      【关键词】 临时心脏起搏器植入术；Ⅲ度房室传导阻滞；心功能；脑钠肽；心肌肌钙蛋白
      【中图分类号】 R541.7+6 【文献标识码】 A 【文章编号】 1003—6350（2017）03—0360—03

Influence of temporary pacemaker implantation on cardiac function, BNP, cTnI and other indexes in thetreatment of patients with Ⅲ degree atrioventricular block.
ZHU Chao-jiang, WEI Gao-hui. Department of InternalMedicine-Cardiovascular, the Second People's Hospital of Jiulongpo District of Chongqing City, Chongqing 400052, CHINA
【Abstract】 Objective To study influence of temporary pacemaker implantation (TPI) on cardiac function, BNP,cTnI and other indexes in the treatment of patients with Ⅲ degree atrioventricular block (Ⅲ -DAB). Methods FromMay 2010 to May 2016, 88 patients withⅢ-DAB were enrolled in the study with TPI for treatment. At the same period,85 cases healthy volunteers in the hospital were selected as the control group. The plasma B-type natriuretic peptide(BNP) and serum cardiac troponin-I (cTnI) of the two groups and the cardiac function indexes before and after TPI treat-ment in the observation group were observed. The correlation among the indexes of the observation group and the prog-nosis of the two groups were analyzed. Results The levels of BNP and cTnI in the observation group were (112.24±17.33) pg/mL and (1.28±0.26) ng/mL, which were significantly higher than (28.53±9.82) pg/mL and (0.03±0.02) ng/mLin the control group (P<0.05). The left ventricular ejection fraction (LVEF) and cardiac index (CI) of the observationgroup after TPI treatment were (69.27±6.33)% and (4.18±0.13) L/min·m2, which were significantly higher than (51.39±3.17)% and (3.15±0.11) L/min·m2 of the observation group before TPI treatment (P<0.05); the left atrial dimension(LAD) and left ventricular ends diastolic dimension (LVEDD) of the observation group after TPI treatment were (31.19±3.06) mm and (42.18±4.13) mm, which were significantly lower than (43.58±5.21) mm and (50.26±5.30) mm of the ob-servation group before TPI treatment (P<0.05). The levels of BNP and cTnI of the observation group patients aftertreatment of TPI were (41.83 ± 9.87) pg/mL and (0.53 ± 0.07) ng/mL, which were significantly lower than (112.24 ±17.33) pg/mL and (1.28±0.26) ng/mL before treatment of TPI (P<0.05). According to the correlation analysis of Spear-man method, in the observation group, the plasma BNP and serum cTnI were negatively correlated with LVEF and CI(r=-5.394, -7.108, -6.024, -6.138), and were positively correlated with LAD and LVEDD (r=6.133, 5.971, 5.421,5.620). In the observation group, the success rate of one-time implantation TPI treatment was 100%, and there was no ob-vious complication after treatment. Conclusion TPI has a good curative effect and safety in the treatment of patientswith typeⅢ -DAB. The plasma BNP and serum cTnI were negatively correlated with LVEF and CI, and were positivelycorrelated with LAD and LVEDD, which is worthy of clinical attention.
      【Key words】 Temporary pacemaker implantation (TPI); Ⅲ degree atrioventricular block (Ⅲ -DAB); Cardiacfunction (CI); B