【摘要】 目的　探讨心脏永久起搏器在高龄患者中的应用 ,并对生理性及非生理性两种起搏方式进行对比研究。方法　为 4 7例年龄≥ 75岁的高龄患者安置VVI型起搏器 2 5例 ,VDD型起搏器 3例 ,DDD型起搏器 19例。术后随访平均 3个月至 2年 ,了解患者自觉症状、生活质量、运动耐量、起搏器功能情况及测定左室射血分数 (EF)。结果　全组病例自觉症状、活动能力及生活质量均明显改善 ,起搏功能良好 ,患者平均心室率由术前的 (4 4± 11)次 /min提高到 (6 9± 16 )次 /min。生理性起搏组EF由 (5 1.7± 16 .8) %提高到 (6 2 .1± 15 .2 ) % (P <0 .0 1) ,1例发生房颤 ;非生理起搏组EF由 (4 8.5± 14 .8) %提高到 (6 0 .1± 16 .9) % (P <0 .0 1) ,2例发生房颤 ,3例出现起搏器综合征。结论　两种起搏方式均可改善高龄患者的生活质量 ,提高心室率 ,改善心功能 ,但生理性起搏可减少起搏器综合征及房颤的发生。更多还原

【Abstract】 Objective To study the application of permanent pacing in elderly patients and the diffterence between physiologic pacing and non-physiologic pacing.Methods Forty-seven patients ≥75 years underwent permanent pacing implantation with VVI(25 cases), VDD(3 cases) and DDD(19 cases).All the patients were followed up for 0.3-2 years on their self-sensing signs and symptoms,living quality,exercise endurance,pacing function and left ventricular ejection function(LVEF). Results All the patients had satisfactory sensing,exercise ability and pacing functions. The ventricuar rate (44±11) beats a minutes before implantation was improved to (69±16) beats a minutes after implantation. LVEF in the implanted physiologic pacing group was improved [( 51.7± 16.8)% vs ( 62.1± 15.2)%,P< 0.01]. One patient( 4.54%) showed atrial arrhythmias( 4.54%). LVEF in the implanted non-physiologic pacing group was improved [( 48.5± 14.8)% vs ( 60.1± 16.9)%,P< 0.01]. Two patients(18%) showed atrial arrhythmias(8%). Three patients(12%) presented pacemaker syndrome. Conclustion Two kinds of pacing modes can improve ventriular rate,cardiac function and living quality. But physiologic pacing is better than non-physiologic VVI pacing in decreasing the occurrence of the atrial arrhythmias and pacemaker syndrome.更多还原