魏会强,汤娇娇,詹贤章,吴书林,陈泗林

• 1:广东省人民医院心血管内科广东省心血管病研究所

摘要(Abstract)：

目的分析起搏器植入术后三尖瓣反流(tricuspid valve regurgitation,TR)的远期发生率,评估术后心脏结构及功能的远期影响,并探讨其影响因素。方法入选广东省人民医院心血管内科2008年至2013年为行永久性起搏器更换而住院的患者共107例,起搏器首次植入前和本次住院更换前行经胸心脏超声检查,对107例患者的心脏超声数据及临床资料进行回顾性分析。再依据起搏器更换前根据心脏超声确定的TR程度分为无意义TR组(81例)和有意义TR组(26例),比较两组患者临床及超声资料,并对有意义TR组进行多因素回归分析。结果 107例患者的平均观察时间(9.5±3.2)年,更换时出现26例(24.3%)有意义TR。与无意义TR组相比,有意义TR组的平均观察时间更长[(10.7±4.4)年比(9.1±2.5)年,P=0.022],出现有意义的二尖瓣反流更多(30.8%比3.7%,P<0.001);植入前右心房内径更大[(47.4±8.0)mm比(44.2±6.8)mm,P=0.045],1级TR发生率更高(53.8%比46.9%,P=0.038);而两组患者植入右心室电极数[(1.2±0.4)根比(1.1±0.3)根,P=0.789]、心室起搏百分比[(50.7±43.1)%比(63.0±42.1)%,P=0.127]、QRS波时限[(121.6±33.2)ms比(130.8±36.5)ms,P=0.283]比较,差异无统计学意义。植入前伴心房颤动(OR 6.203,95%CI 1.211~31.785)、植入年限(OR 1.245,95%CI 1.038~1.479)、轻度TR(OR1.885,95%CI 1.002~3.670)、右心房内径(OR 1.137,95%CI 1.025~1.260)是起搏器植入术后发生有意义TR的影响因素。结论起搏器植入术后远期可增加TR发生率,且出现有意义TR与植入前伴心房颤动、植入年限、右心房内径的扩大、存在轻度TR相关。

关键词(KeyWords)： 永久性起搏器;三尖瓣反流;心脏超声

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 魏会强,汤娇娇,詹贤章,吴书林,陈泗林

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