频率适应性起搏器对老年病态窦房结综合征患者生活质量的影响
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摘要
目的：观察老年病态窦房结综合征患者，植入频率适应性起搏器后生活质量、心脏功能及运动耐量等改变，以探讨频率适应性起搏器对老年患者生活质量的影响。方法：经临床、食管心房调搏、动态心电图和运动试验确诊且合并窦房结变时功能不全的30例老年病态窦房结综合征患者，择期植入永久双腔频率适应性起搏器(DDDR)，于起搏器植入术后即刻及12个月后将起搏器分别程控为非频率适应性起搏模式(DDD)和频率适应性起搏模式(DDDR)。两种模式下起搏器各工作12个月，定期随访，采用SF-36生活质量调查表，进行问卷调查；动态心电图(DCG)监测24小时日常活动时心率变化：症状限制性活动平板运动试验观察运动持续时间，最大起搏频率：超声心动图测定最大运动负荷时每搏量、每分心输出量。结果：本组患者DDDR模式下与DDD模式下相比SF-36调查表的总得分差别有统计学意义(118.6±7.12 VS 95.27±7.56，t=12.31，P＜0.001)：运动持续时间和最大心输出量差别亦有统计学意义(386.20±67.72s VS 274.10±56.88s，t=6.94，P＜0.001；9.97±1.03l／min VS 6.30±0.79 l／min，t=15.41，P＜0.001)。最大运动负荷时两种起搏模式的每搏量差别无统计学意义(71.57±5.35ml VS 70.67±5.42ml，t=0.65，P=0.52)。结论：频率适应性起搏器可明显改善老年病态窦房结综合征患者的生活质量和运动耐量。
Objective: To investigate the effect on Quality-of-Life(QOL) of rate adaptive pacemaker in old patients with sick sinus symptom(SSS). Methods: 30 old patients had SSS accompanied with chronotropic incompetence in terms of clinical manifestation, h olter and tread mill were implanted the dual chamber pacing(DDDR). Pacemakers were respectively programmed without and with adaptive demand mode in the implantation instantly and 12months later. The SF-36 was used to measure quality of life without and with adaptive demand mode, the pacing rate, cardiac out-put and exercise capacity were measured by tread mill, echocardiography and holter during exercise test and daily activities in tow different mode. Results: The scores of SF-36 were significantly increased (118.6±7.12 VS 95.27±7.56, t=12.31, P<0.001) in DDDR mode and the scores about five aspects of SF-36, which included physical functioning, physical role, general health, vitality and social functional were better than in DDD mode.(except for body pain, emotional role and mental health).Compared with DDD mode, the exercise time and cardiac out-put of 30 patients were significantly increased(386.20±67.72s VS 274.10±56.88s, t=6.94, P<0.001; 9.97±1.03 1/ min VS 6.30±0.79 1/ min, t=15.41, P<0.001). However there were no significant difference between the tow mode in the stroke volume (71.57±5.35ml VS 70.67±5.42ml, t=0.65, P=0.52) Conclusions: The implantation of DDDR improves health-related quality of life, meet with requirement of
Objective: To investigate the effect on Quality-of-Life(QOL) of rate adaptive pacemaker in old patients with sick sinus symptom(SSS). Methods: 30 old patients had SSS accompanied with chronotropic incompetence in terms of clinical manifestation, h olter and tread mill were implanted the dual chamber pacing(DDDR). Pacemakers were respectively programmed without and with adaptive demand mode in the implantation instantly and 12months later. The SF-36 was used to measure quality of life without and with adaptive demand mode, the pacing rate, cardiac out-put and exercise capacity were measured by tread mill, echocardiography and holter during exercise test and daily activities in tow different mode. Results: The scores of SF-36 were significantly increased (118.6±7.12 VS 95.27±7.56, t=12.31, P<0.001) in DDDR mode and the scores about five aspects of SF-36, which included physical functioning, physical role, general health, vitality and social functional were better than in DDD mode.(except for body pain, emotional role and mental health).Compared with DDD mode, the exercise time and cardiac out-put of 30 patients were significantly increased(386.20±67.72s VS 274.10±56.88s, t=6.94, P<0.001; 9.97±1.03 1/ min VS 6.30±0.79 1/ min, t=15.41, P<0.001). However there were no significant difference between the tow mode in the stroke volume (71.57±5.35ml VS 70.67±5.42ml, t=0.65, P=0.52) Conclusions: The implantation of DDDR improves health-related quality of life, meet with requirement of
引文
[1] Buckingham T., Woodruff R., Pennington G., et al. Effect of ventricular function on the exercise hemodynamics of variable rate pacing. J. Am Coll Cardiol, 1988, 11: 1269
[2] Humen DP., Kostuk WJ., Klein GJ. Activity-sensing rate responsive pacing: improvement in myocardial performance with exercise. PACE, 1985, 1: 52
[3] 汪康平，刘志华，谢崇伦，等．生理性起搏的临床应用和适应症选择[J]．起搏与心脏，1991，5：18
[4] 马坚，王方正，于培桢，等．频率适应式起搏器的临床应用和生理性起搏效应[J]．心脏起搏与心电生理杂志，1995，9：(2)：68-70
[5] Gergoratos G. Permanent pacemakers in older persons. J Am Geriatr Soc 1999: 47(9): 1125-35
[6] Tsang TS, Gersh BJ, Appleon CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002; 40(9): 1636-44
[7] Ware JE., Wherbourne CD. The MOS36-item short from health survey(SF-36): IConceptual framework and item selection [J]. Med Care, 1992, 30: 473
[8] 伯纳德 (Bernard，RC．)．运动负荷试验．见：(美)布朗威(BRAUNWALD)著．心脏病学[M]．陈灏珠主译．北京：人民卫生出版社，1999．153-163
[9] Boeg, G.:Perceived exertion as an indicator of somatic stress. Scand. J. Rehabil. Med. 2-3: 92, 1970.
[10] Lind C. Quality of life in pacemaker and implantable cardioverter defibrillor recipients. PACE. 2000, 23: 931-933[11] 张代民，郭涛，李淑敏，等．优化起搏器参数改善患者生活质量初探[J]．岭南心血管杂志．2003，9(1)：6-8
[12] 凌峰．频率适应性起搏的临床应用．见：沈法荣，郑良荣，徐耕主编．现代心脏起搏治疗学[M]第1版．上海：上海科学技术出版社，2004．133
[13] Maloney JD., Helguera ME., Woscoboinik JR., et al. Physiology of rate-responsive pacing[J]. Cardiology Clinics. 1992. 10: 619
[14] 张技革，杨浣宜，李建蓉，等．运动负荷超声心动图评价起博器频率适应者的心功能[J]．中国超声医学杂志，2004，20(5)：352-354[1] 王士雯，卢才义．老年心脏的生理与临床．见：苏静怡，李澈，苏哲坦主编，心脏：从基础到临床[M]．第1版．北京：北京医科大学．中国协和医科大学联合出版社，1999．532-537
[2] 王敏武，葛怀珠，李玉新等．老年人病态窦房结综合征的电生理研究[J]．中华老年医学杂志，1996，15(5)：283-285
[3] Dreifus LS, Fisch C, Griffin JC, et al. Gulidelines for implantation of cardiac pacemaker and antiarrhythmia devices[J]. J Am Coll Cardiol. 1991, 18: 1-13
[4] 凌峰，频率适应性起搏的临床应用。见：沈法荣，郑良荣，徐耕主编．现代心脏起搏治疗学[M]第1版，上海：上海科学技术出版社，2004．133
[5] Ellestad MH, Wan MK. Predictive implications of stress testing: follow-up of 2700 subjects after maximum treadmill stress testing. Circulation. 1975; 51: 363-369
[6] Brandt, J., and Schuller, H. Consideration for the selection of rate-adaptive single lead atrial (AAIR) pacing. In Barold,S.S., and Mugica. J. (eds): New Perspectives in Cardiac Pacing 3.Mt.Kisco. N. Y. Futura. 1993. p. 349
[7] Roderhefer RJ. Exereise cardial output is maintained with advancing age in health human subjects: Cardiac dilatation and increased stroke volum compensate for a diminished heart rate. Circulation, 1984, 69: 203
[8] 张技革，杨浣宜，李建蓉，等．运动负荷超声心动图评价起博器频率适应者的心功能[J]．中国超声医学杂志，2004，20(5)：352-354
[9] Ferro A, Duilio C, Santomanro M, et al. Walk test at increased levels of heart rate in patients with dualehamber pacemaker and with wormal or depresstd left ventricular function Enr Heart??J: 2003 24(23): 2123-21; 2
[10] 钱亚民，冯建章，吴书林，等．体动感知式频率适应性起博器应变牲的初步探讨[J]．中华心律失常杂志，1999，3(1)：42
[11] 孙瑞龙．充血性心力衰竭与起博器治疗[J]．中国循环杂志，1996，11(9)：515
[12] Epperlein S, Kreft A, Siegert V, et al. DDD versus DDDR pacemaker stimulation comparison of cardiopulmonary performance, incidence of atrial arrhythmias and quality of life[J]. Z Kardiol, 1996, 85(4): 226-36
[13] 蔡杏林，黄定九，辛隆泉．体动感知频率应答型起博器的频率应答及运动耐量观察[J]．心脏起博与心电生理杂志．1994．8(2)：81
[14] Jutzy, R. V., Isaeff, D. M., Bansal,R.C., et al. Comparison of VVIR, DDD, and DDDR acing. J. Electrophysial. 3: 194, 1989
[15] Batey, R.,Sweesy, M..V.,Scala,G., et al.Comparion of low rate dual chamber pacing to activity responsive rate variable ventricular paving.PACE 13: 646,1990
[16] Lamas GA, Orav EJ, stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med, 1998,338(16): 1097-1104
[17] Lamas GA, Lee KL, Sweeney MD, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med, 2002; 346(24): 1854-1862
[18] Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation,2003; 107(23):2932-2937
[19] Sulke, N., Chambers, J., Dritsas, A., et al. A randomized doubleblind crossover comparison of four rate-responsive pasing??modes.J.Am.coll. Cardial 17:696,1991
[20] Mark S. Link, MD, Anne S., et al. High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST).J. Am Coll Cardiol, 2004; 43:2066-2071
[21] Frencis GS,Cohn JN,Johnson G, et al. Plasma norepine ph plasma rennin and the effects of therapy in V-HeFT Ⅱ[J]. Circulation, 1993,87(suppl Ⅵ):40
[22] Theodorakis G, kremastinos D,Markianos M,et al.C-AMP and ANP level in ⅤⅥ and DDD pacing with different AV delays during daily activity and exercise[J].PACE, 1999,13:1773
[23] Prinzen F, Peschar M. Relation between the pacing induced sequence of activation and left ventricular pump function in animals..Pacing Clin Electrophysiol,2002:25(4 Pt 1):484-498
[24] 陈健，蓝锋，黄达军．病窦综合征安装VVIR起博器109例运动耐量的分析[J]．心血管康复医学杂志．2003．6．(12)(13)：255
[25] Kristensen L, Nielsen J C, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome[J]. Heart, 2004; 90(6):661-666
[26] Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome[J]. AM Coll Caroliol, 2003;42(4):614-623
[27] 崔长琮，王忠，马奕，等．人工心脏起博的血液动力学研究进展[J]．心脏起博与心电生理杂志，1994．8(4)：217
[28] Maloney JD, Helguera ME, Woscoboinik JR, et al. Physiology of rate-responsive pscing[J].Cardiology clinics, 1992, 10(4):619-33
[2] Humen DP., Kostuk WJ., Klein GJ. Activity-sensing rate responsive pacing: improvement in myocardial performance with exercise. PACE, 1985, 1: 52
[3] 汪康平，刘志华，谢崇伦，等．生理性起搏的临床应用和适应症选择[J]．起搏与心脏，1991，5：18
[4] 马坚，王方正，于培桢，等．频率适应式起搏器的临床应用和生理性起搏效应[J]．心脏起搏与心电生理杂志，1995，9：(2)：68-70
[5] Gergoratos G. Permanent pacemakers in older persons. J Am Geriatr Soc 1999: 47(9): 1125-35
[6] Tsang TS, Gersh BJ, Appleon CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002; 40(9): 1636-44
[7] Ware JE., Wherbourne CD. The MOS36-item short from health survey(SF-36): IConceptual framework and item selection [J]. Med Care, 1992, 30: 473
[8] 伯纳德 (Bernard，RC．)．运动负荷试验．见：(美)布朗威(BRAUNWALD)著．心脏病学[M]．陈灏珠主译．北京：人民卫生出版社，1999．153-163
[9] Boeg, G.:Perceived exertion as an indicator of somatic stress. Scand. J. Rehabil. Med. 2-3: 92, 1970.
[10] Lind C. Quality of life in pacemaker and implantable cardioverter defibrillor recipients. PACE. 2000, 23: 931-933[11] 张代民，郭涛，李淑敏，等．优化起搏器参数改善患者生活质量初探[J]．岭南心血管杂志．2003，9(1)：6-8
[12] 凌峰．频率适应性起搏的临床应用．见：沈法荣，郑良荣，徐耕主编．现代心脏起搏治疗学[M]第1版．上海：上海科学技术出版社，2004．133
[13] Maloney JD., Helguera ME., Woscoboinik JR., et al. Physiology of rate-responsive pacing[J]. Cardiology Clinics. 1992. 10: 619
[14] 张技革，杨浣宜，李建蓉，等．运动负荷超声心动图评价起博器频率适应者的心功能[J]．中国超声医学杂志，2004，20(5)：352-354[1] 王士雯，卢才义．老年心脏的生理与临床．见：苏静怡，李澈，苏哲坦主编，心脏：从基础到临床[M]．第1版．北京：北京医科大学．中国协和医科大学联合出版社，1999．532-537
[2] 王敏武，葛怀珠，李玉新等．老年人病态窦房结综合征的电生理研究[J]．中华老年医学杂志，1996，15(5)：283-285
[3] Dreifus LS, Fisch C, Griffin JC, et al. Gulidelines for implantation of cardiac pacemaker and antiarrhythmia devices[J]. J Am Coll Cardiol. 1991, 18: 1-13
[4] 凌峰，频率适应性起搏的临床应用。见：沈法荣，郑良荣，徐耕主编．现代心脏起搏治疗学[M]第1版，上海：上海科学技术出版社，2004．133
[5] Ellestad MH, Wan MK. Predictive implications of stress testing: follow-up of 2700 subjects after maximum treadmill stress testing. Circulation. 1975; 51: 363-369
[6] Brandt, J., and Schuller, H. Consideration for the selection of rate-adaptive single lead atrial (AAIR) pacing. In Barold,S.S., and Mugica. J. (eds): New Perspectives in Cardiac Pacing 3.Mt.Kisco. N. Y. Futura. 1993. p. 349
[7] Roderhefer RJ. Exereise cardial output is maintained with advancing age in health human subjects: Cardiac dilatation and increased stroke volum compensate for a diminished heart rate. Circulation, 1984, 69: 203
[8] 张技革，杨浣宜，李建蓉，等．运动负荷超声心动图评价起博器频率适应者的心功能[J]．中国超声医学杂志，2004，20(5)：352-354
[9] Ferro A, Duilio C, Santomanro M, et al. Walk test at increased levels of heart rate in patients with dualehamber pacemaker and with wormal or depresstd left ventricular function Enr Heart??J: 2003 24(23): 2123-21; 2
[10] 钱亚民，冯建章，吴书林，等．体动感知式频率适应性起博器应变牲的初步探讨[J]．中华心律失常杂志，1999，3(1)：42
[11] 孙瑞龙．充血性心力衰竭与起博器治疗[J]．中国循环杂志，1996，11(9)：515
[12] Epperlein S, Kreft A, Siegert V, et al. DDD versus DDDR pacemaker stimulation comparison of cardiopulmonary performance, incidence of atrial arrhythmias and quality of life[J]. Z Kardiol, 1996, 85(4): 226-36
[13] 蔡杏林，黄定九，辛隆泉．体动感知频率应答型起博器的频率应答及运动耐量观察[J]．心脏起博与心电生理杂志．1994．8(2)：81
[14] Jutzy, R. V., Isaeff, D. M., Bansal,R.C., et al. Comparison of VVIR, DDD, and DDDR acing. J. Electrophysial. 3: 194, 1989
[15] Batey, R.,Sweesy, M..V.,Scala,G., et al.Comparion of low rate dual chamber pacing to activity responsive rate variable ventricular paving.PACE 13: 646,1990
[16] Lamas GA, Orav EJ, stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med, 1998,338(16): 1097-1104
[17] Lamas GA, Lee KL, Sweeney MD, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med, 2002; 346(24): 1854-1862
[18] Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation,2003; 107(23):2932-2937
[19] Sulke, N., Chambers, J., Dritsas, A., et al. A randomized doubleblind crossover comparison of four rate-responsive pasing??modes.J.Am.coll. Cardial 17:696,1991
[20] Mark S. Link, MD, Anne S., et al. High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST).J. Am Coll Cardiol, 2004; 43:2066-2071
[21] Frencis GS,Cohn JN,Johnson G, et al. Plasma norepine ph plasma rennin and the effects of therapy in V-HeFT Ⅱ[J]. Circulation, 1993,87(suppl Ⅵ):40
[22] Theodorakis G, kremastinos D,Markianos M,et al.C-AMP and ANP level in ⅤⅥ and DDD pacing with different AV delays during daily activity and exercise[J].PACE, 1999,13:1773
[23] Prinzen F, Peschar M. Relation between the pacing induced sequence of activation and left ventricular pump function in animals..Pacing Clin Electrophysiol,2002:25(4 Pt 1):484-498
[24] 陈健，蓝锋，黄达军．病窦综合征安装VVIR起博器109例运动耐量的分析[J]．心血管康复医学杂志．2003．6．(12)(13)：255
[25] Kristensen L, Nielsen J C, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome[J]. Heart, 2004; 90(6):661-666
[26] Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison ofatrial and dual-chamber pacing in177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome[J]. AM Coll Caroliol, 2003;42(4):614-623
[27] 崔长琮，王忠，马奕，等．人工心脏起博的血液动力学研究进展[J]．心脏起博与心电生理杂志，1994．8(4)：217
[28] Maloney JD, Helguera ME, Woscoboinik JR, et al. Physiology of rate-responsive pscing[J].Cardiology clinics, 1992, 10(4):619-33