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目的观察不同方式起搏时血浆儿茶酚胺（ＣＡ）、心钠素（ＡＮＰ）及内皮素（ＥＴ）水平的变化。探讨维持房室活动同步的重要性。方法１９例植入起搏器治疗的病人，分别于起搏器植入术中、术后不同方式起搏后采血测量血浆ＣＡ、ＡＮＰ及ＥＴ浓度。术前及术后行超声心动图检查。术后按永久性起搏方式将病人分为心室按需起搏（ＶＶＩ）组和双腔起搏（ＤＤＤ）组进行比较。结果术中ＶＶＩ及室房顺序起搏（Ｖ－Ａ）后血浆去甲肾上腺素（ＮＥ）水平均显著升高（Ｐ均＜０．００１），且Ｖ－Ａ升高幅度更大（组间比较Ｐ＜０．０１）。术后２４小时及７天ＶＶＩ组ＮＥ水平仍显著高于ＤＤＤ组（Ｐ＜０．０５）。术中ＶＶＩ及Ｖ－Ａ起搏后ＡＮＰ水平均显著升高（Ｐ均＜０．００１），２组间比较差异不显著，但分别与房室顺序（Ａ－Ｖ）起搏比较则有显著差异（Ｐ＜０．０１）。术后２４小时、７天ＶＶＩ组ＡＮＰ水平显著高于ＤＤＤ组（Ｐ＜０．０１）。术中及术后各种方式中，只有Ｖ－Ａ起搏后ＥＴ水平显著上升（Ｐ＜０．００１）。动脉收缩压、平均压只在术中Ｖ－Ａ起搏时有明显下降。超声心动图测量结果显示ＤＤＤ起搏在改善心室充盈及提高心排量方面明显优于ＶＶＩ起搏。结论房室非同步起搏，尤其在伴有逆行房室?
Objective To observe the changes of plasma catecholamine (CA), atrial natriuretic peptide (ANP) and endothelin (ET) in different modes of pacing. Explore the importance of keeping your atrioventricular activity synchronized. Methods Nineteen patients with pacemaker were enrolled in this study. Plasma concentrations of CA, ANP and ET were measured during postoperative pacemaker implantation and postoperative pacing. Preoperative and postoperative echocardiography. Patients were divided into ventricular on-demand pacing (VVI) group and double-lumen pacing (DDD) group by permanent pacing after operation. Results The levels of plasma norepinephrine (NE) in VVI and ventricular pacing (V-A) were significantly increased (all P <0.001) and V-A increased more significantly Compare P <0.01). The levels of NE in VVI group at 24 and 7 days after operation were still significantly higher than those in DDD group (P <0.05). Intraoperative VVI and V-A pacing ANP levels were significantly increased (P all <0.001), no significant difference between the two groups, but respectively with the atrioventricular (A-V) pacing were significantly Difference (P <0.01). The level of ANP in VVI group was significantly higher than that in DDD group at 24 hours and 7 days after operation (P <0.01). Among the various modes during and after operation, only ET level after V-A pacing significantly increased (P <0.001). Arterial systolic pressure, mean pressure only decreased significantly during intraoperative V-A pacing. Echocardiographic measurements showed that DDD pacing was significantly better than VVI pacing in improving ventricular filling and improving cardiac output. Conclusion Atrioventricular pacing, especially in patients with retrograde atrioventricular?