摘要目的：探讨双心室起搏与右心室间隔部起搏治疗房室传导阻滞对起搏依赖患者生活质量和心功能的影响。方法入选20例需行起搏治疗的Ⅱ度Ⅱ型、高度或Ⅲ度房室传导阻滞患者，均安置三腔起搏器。按心室起搏方式不同，应用数字表随机程控分为A组（右心室间隔部起搏组，关闭左心室电极，10例）和B组（双心室起搏组，10例）。12个月后交叉治疗，A组程控为双心室起搏，B组程控为右心室间隔部起搏，继续随访12个月。比较两种起搏方式对观察指标的影响，包括患者6 min 步行距离（6MWD）、明尼苏达心力衰竭生活质量评分（MLHFQ）、血浆N末端脑钠肽前体（NT?proBNP）、左心室射血分数（ LVEF）、左心室舒张末期内径（ LVEDD）、左心室收缩末期内径（ LVESD）、左心室十二节段达峰时间标准差（Ts?12SD）、左心室十二节段达峰时间最大延迟（Ts?dif）、起搏QRS波宽度（QRSd）。结果 A组患者治疗12和24个月后6MWD明显增加[（242?58±37?56）、（347?42±36?59）、（340?67±24?99） m]， LVEF明显增加[（39?97±5?84）％、（57?92±10?01）％、（60?50±10?06）％]， QRSd 明显变窄[（139?25±10?43）、（114?25±10?07）、（110?83±11?08） ms]，NT?proBN 含量显著降低[（2857?84±236?48）、（2144?26±301?43）、（2025?91±307?42） ng／L]；B 组患者治疗12和24个月后6MWD 明显增加[（228?17±38?06）、（329?33±46?28）、（350?67±35?43） m]，LVEF明显增加[（40?25±11?24）％、（59?50±9?14）％、（60?17±10?29）％]，QRSd 明显变窄[（142?42±10?66）、（118?58±9?94）、（116?25±10?59） ms]，NT?proBNP含量显著降低[（2848?25±318?65）、（2144?26±301?43）、（2025?91±307?42） ng／L]，组内与治疗前比较差异均有统计学意义（P 均＜0?05），而组间各时间比较差异均无统计学意义（P 均＞0?05）。结论与右心室间隔部起搏相比，双心室起搏对起搏依赖房室传导阻滞患者的生活质量和心功能影响未显示出优势。

abstractsObjective Respectively applying the treatment of biventricular pacing and right ventricular septal pacing in atrioventricular block,to compare the heart function influence of two kinds of pacing mode on pacemaker dependent patients, to provide evidence for the physiological pacing mode selection?Methods Enrolled 20 patients from January 2012 to March 2013 who should be placed in pacemakers, their primary disease was the second degree,high or third degree atrioventricular block,giving them three chamber pacemaker ( right atrial + biventricular ) each?Randomly divided into right ventricular septum pacing group ( group A, n=10) and biventricular pacing group( group B,n=10)?Twelve months later,each group crossed into the each other group and continued following?up for 12 months?After 24 months to obtain all the data to do the statistical analysis,including patients'6 min walking distance(6MWD),the Minnesota Heart Failure Quality of life score (MLHFQ),plasma N?terminal pro brain natriuretic peptide precursor(NT?proBNP),left ventricular ejection ejection fraction(LVEF),left ventricular diastolic end diastolic diameter(LVEDD),left ventricular contraction end diastolic diameter(LVESD),left ventricular twelve segmental 14W time standard deviation(Ts?12SD),left ventricular twelve segmental 14W time maximum delay(Ts?dif),the paced QRS qrsd?Results Compared with group B,the 6MWD and LVEF of 12,24 months after treatment of group A were significantly increased( ( 242?58 ±37?56) m vs?(347?42±36?59) m vs?(340?67±24?99) m;(39?97±5?84)% vs?(57?92±10?01)% vs?(60?50±10?06)%;P<0?05),QRSd and NT?proBN were significantly decreased((139?25±10?43) ms vs?(114?25±10?07) ms vs?(110?83±11?08) ms) ms;( 2 857?84±236?48) ng/L vs?( 2 144?26±301?43) ng/L vs? (2 025?91±307?42) ng/L;P<0?05)?Compared with before treatment,at 12 and 24 months after treatment,6MWD in group B was significantly increased(228?17+38?06) m,(329?33+46?28) m,(350?67+35?43) m, LVEF was significantly increased ( ( 40?25+11?24 )% vs? ( 59?50+9?14 )% vs? ( 60?17+10?29)%),QRSd significantly narrowed((142?42+10?66) ms vs?(118?58+994) ms vs?(116?25+10?59) ms) and NT proBNP levels significantly reduced((2 848?25+318?65) ng/L vs?(2 144?26+301?43) ng/L vs?( 2 025?91+30?742) ng/L) were,the difference had statistical significance ( P<0?05)?There was no significant difference on the different time between the groups ( P=0?05)?Comparisons between A and B group at the same treatment time,these indexes of detections were no statistical significance(P>0?05)?Conclusion Compared with the right septal pacing,biventricular pacing is of no significant advantages on the effect of cardiac function for patients with pacemaker dependent.