实用老年医学

实用老年医学 ›› 2023, Vol. 37 ›› Issue (8): 781-784.doi: 10.3969/j.issn.1003-9198.2023.08.007

• 临床研究 • 上一篇    下一篇

老年病人起搏器植入术后三尖瓣反流的影响因素分析

卢妙, 陆小伟, 王璎瑛   

  1. 210029 江苏省南京市,南京医科大学第一附属医院(江苏省人民医院)老年心血管科
  • 收稿日期:2022-10-10 出版日期:2023-08-20 发布日期:2023-08-28
  • 通讯作者: 王璎瑛,Email:wangyingying419@163.com
  • 基金资助:
    江苏省卫健委科研基金资助项目(LKZ2022001)

Analysis of influencing factors of tricuspid regurgitation after pacemaker implantation in elderly patients

LU Miao, LU Xiao-wei, WANG Ying-ying   

  1. Department of Geriatric Cardiology,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People's Hospital), Nanjing 210029, China
  • Received:2022-10-10 Online:2023-08-20 Published:2023-08-28
  • Contact: WANG Ying-ying, Email:wangyingying419@163.com

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摘要： 目的 分析老年病人心脏起搏器植入术后三尖瓣反流(tricuspid regurgitation, TR)发生或发展的影响因素。 方法 回顾分析2012年1月至2021年1月在我科行心脏起搏器植入的264例老年病人术后TR的情况。术后出现新的TR或TR程度较术前加重的病人为加重组,其余为未加重组。比较2组病人的术前临床资料及二维超声心动图参数,并对病人术后TR的影响因素行多因素Logistic回归分析。 结果 264例植入起搏器的老年病人中,新发TR或TR加重共87例,发生率为33.0%。加重组年龄,术前三尖瓣轻度反流、右室心尖起搏比例及植入年限高于未加重组(P＜0.01);左心房内径(LAD)、右心房内径(RAD)大于未加重组(P＜0.01)。Logistic回归分析表明, RAD增大、术前三尖瓣轻度反流、右室心尖起搏、植入年限是植入心脏起搏器术后TR发生或发展的独立影响因素(P＜0.05)。 结论 老年病人术前RAD增大、起搏电极位于右室心尖部、心脏起搏器植入年限长是术后TR发生或发展的危险因素,术前三尖瓣轻度反流是术后TR发生或发展的保护因素。

关键词: 永久性心脏起搏器, 电极导线介导三尖瓣反流, 右心室起搏, 右室心尖起搏

Abstract: Objective To analyze the factors affecting the occurrence of tricuspid regurgitation(TR) after pacemaker implantation in the elderly patients. Methods A retrospective analysis of the clinical data of 264 elderly patients who were implanted with pacemakers in our department from January 2012 to January 2021 was performed. All patients were divided into lead induced tricuspid regurgitation (LITR)group and no LITR group according to whether they experienced an exacerbation of TR or a new TR occurred after surgery or not. The pre-operation clinical data and the indexes of two-dimensional echocardiographic measurements between the two groups were compared. The influencing factors of LITR in the elderly patients were analyzed by multivariate Logistic regression model. Results LITR occurred in 87 out of 264 elderly patients with pacemaker implantation, and the incidence rate of LITR was 33.0%. There were significant differences between the two groups in age, the rates of mild preoperative TR, right ventricular apical pacing, and years of implantation(P<0.01). The left atrial diameter(LAD) and right atrial diameter(RAD) in LITR group were significantly higher than those in no LITR group(P<0.01). Multivariate Logistic regression analysis showed that higher RAD, mild preoperative TR, right ventricular apical pacing and years of pacemaker implantation were the influencing factors of the occurrence and exacerbation of TR after pacemaker implantation(P<0.05). Conclusions Increased RAD, pacing electrodes located in the right ventricular apex and long years of pacemaker implantation are risk factors, and mild preoperative TR is a protective factor for postoperative TR.

Key words: permanent pacemaker, lead-induced tricuspid regurgitation, right ventricular pacing, right ventricular apical pacing

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