双室心脏电刺激器植入后心动过缓患者的止血系统状态的研究

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论证：与许多其他外科干预一样，在近段或远段植入心脏电刺激器（EX）可能伴随着不利的结果。寻找不良结果的可能危险因素有助于开发有效和安全的方法来管理术后期使用心脏电刺激器的患者。研究植入心脏电刺激器对患者止血系统的影响是目前该领域的研究方向之一。

目的：评估植入双室心脏电刺激器对不同类型慢速心律失常患者止血系统的影响，并确定该组患者不良后果的可能危险因素。

材料与方法：本研究在俄罗斯基础研究基金会资助下，在第19-315-90109号科学项目框架内开展。在一项前瞻性研究（ClinicalTrials.gov ID NCT04499612）中，包括61例患者（男性为45.9%），平均年龄为71.5±8.8岁。手术组包括房室传导阻滞（AB）为23例和窦房结无力综合征（SSS） 为25例，保守组包括房室传导阻滞和窦房结无力综合征为13例，但无心脏电刺激器植入指征。1例房室传导阻滞患者、12例窦房结无力综合征患者、5例保守组患者接受抗凝治疗。其余患者接受抗血小板治疗。测定纤维蛋白原（FI）水平及凝血因子VIII（FVIII）、IX（FIX）、抗凝血酶III （АТ III）、蛋白C活性，对手术组患者于心脏电刺激器植入前及植入后7天行上肢、下肢静脉超声检查及外周血静脉血采集。在C组，只有在研究中才进行类似的检查。

结果：房室传导阻滞患者术后7天血FI水平显著升高（p=0.042）。组间比较发现，手术组植入术后患者AT III活性高于保守组（p=0.018，p=0.006）。术后，窦房结无力综合征患者在抗凝治疗背景下，FVIII和FIX活性低于抗血小板治疗背景下（p=0.048和p=0.015）。根据ROC分析，房室阻滞患者死亡的危险因素是AT III活性降低，窦房结无力综合征患者的FIX活性增加。

结论：在植入心脏电刺激器后至少7天内，房室阻滞患者在抗血小板治疗中止血系统的平衡向高凝状态转移。在窦房结无力综合征患者中使用抗凝剂提供了向低凝的转变。房室传导阻滞患者的AT III活性降低和窦房结无力综合征患者的FIX活性增加是手术后一年内死亡的预后因素。

作者简介

Roman Kalinin

Ryazan State Medical University

Email: kalinin-re@yandex.ru
ORCID iD: 0000-0002-0817-9573
SPIN 代码: 5009-2318

MD, Dr.Sci.(Med.), Professor, Head of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy

俄罗斯联邦, Ryazan

Igor Suchkov

Ryazan State Medical University

Email: suchkov_med@mail.ru
ORCID iD: 0000-0002-1292-5452
SPIN 代码: 6473-8662
Scopus 作者 ID: 56001271800
Researcher ID: M-1180-2016

MD, Dr.Sci.(Med.), Professor, Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy

俄罗斯联邦, Ryazan

Vladislav Povarov

Ryazan State Medical University

Email: povarov.vladislav@mail.ru
ORCID iD: 0000-0001-8810-9518

MD, Cand. Sci. (Med.)

俄罗斯联邦, Ryazan

Nina Mzhavanadze

Ryazan State Medical University

Email: nina_mzhavanadze@mail.ru
ORCID iD: 0000-0001-5437-1112
SPIN 代码: 7757-8854
Researcher ID: M-1732-2016

MD, PhD, Associate Professor of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy; Senior Researcher at the Central Research Laboratory

俄罗斯联邦, Ryazan

Olga Jurina

Ryazan State Medical University

编辑信件的主要联系方式.
Email: povarov.vladislav@mail.ru
ORCID iD: 0000-0002-2159-582X

MD, Cand. Sci. (Med.)

俄罗斯联邦, Ryazan

参考

  1. Raatikainen MJP, Arnar DO, Merkely B, et al. A Decade of Information on the Use of Cardiac Implantable Electronic Devices and Interventional Electrophysiological Procedures in the European Society of Cardiology Countries: 2017 Report from the European Heart Rhythm Association. Europace. 2017;19(suppl 2):ii1–90. doi: 10.1093/europace/eux258
  2. Kalinin RE, Suchkov IA, Mzhavanadze ND, et al. Endothelial dysfunction in patients with cardiac implantable electronic devices (literature review). Science of the young (Eruditio Juvenium). 2016;(3):84–92. (In Russ).
  3. Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin–American Heart Rhythm Society (LAHRS). Europace. 2021;23(7):983–1008. doi: 10.1093/europace/euaa367
  4. Gillam MH, Pratt NL, Inacio MCS, et al. Rehospitalizations for complications and mortality following pacemaker implantation: A retrospective cohort study in an older population. Clinical Cardiology. 2018;41(11):1480–6. doi: 10.1002/clc.23091
  5. Kivva VN, Abramova TN. Pathogenesis of heart failure. Astrakhanskiy meditsinskiy zhurnal. 2009;4(1):73–81. (In Russ).
  6. Kalinin RE, Suchkov IA, Mzhavanadze ND, et al. Dynamics of Coagulation Parameters and Their Relationshipwith Venous Thromboembolic Events in Patients with Cardiac Implantable Electronic Devices. Flebologiya. 2019;13(1):21–7. (In Russ). doi: 10.17116/flebo20191301121
  7. Edwards SJ, Karner C, Trevor N, et al. Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation. Health Technology Assessment. 2015;19(65):1–210. doi: 10.3310/hta19650
  8. Kalinin RE, Suchkov IA, Mzhavanadze ND, et al. Congenital complete heart block in pregnant women: a multidisciplinary approach to diagnosis and treatment. I.P. Pavlov Russian Medical Biological Herald. 2016;(3):80–6. (In Russ).
  9. Venher IK, Rusin VI, Kostiv SY, et al. Hypercoagulable Syndrome in the Early Postoperative Period is a Factor of Venous Thromboembolism. Novosti Khirurgii. 2017;25(3):267–72. (In Russ). doi: 10.18484/2305-0047.2017.3.267
  10. Zhang X, Li Y, Wang N, et al. Effects of permanent cardiac pacemaker implantation on vascular endothelial function, blood coagulation and cardiac function in patients with bradycardia. Experimental and Therapeutic Medicine. 2018;16(6):4717–21. doi: 10.3892/etm.2018.6808
  11. van Rooden CJ, Molhoek SG, Rosendaal FR, et al. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. Journal of Cardiovascular Electrophysiology. 2004;15(11):1258–62. doi: 10.1046/j.1540-8167.2004.04081.x
  12. Mandal S, Pande A, Mandal D, et al. Permanent pacemaker-related upper extremity deepvein thrombosis: a series of 20 cases. Pacing and Clinical Electrophysiology. 2012;35(10):1194–8. doi: 10.1111/j.1540-8159.2012.03467.x
  13. Korkeila P, Mustonen P, Koistinen J, et al. Clinical and laboratory risk factors of thrombotic complications after pacemaker implantation: a prospective study. Europace. 2010;12(6):817–24. doi: 10.1093/europace/euq075
  14. Aarsetøy R, Ten Cate H, Spronk H, et al. Activated factor XI-antithrombin complex presenting as an independent predictor of 30-days mortality in out-of-hospital cardiac arrest patients. Thrombosis Research. 2021;204(15):1–8. doi: 10.1016/j.thromres.2021.05.014
  15. Staudacher DL, Putz V, Heger L, et al. Direct factor IXa inhibition with the RNA-aptamer pegnivacogin reduces platelet reactivity in vitro and residual platelet aggregation in patients with acute coronary syndromes. European Heart Journal. Acute Cardiovascular Care. 2019;8(6):520–6. doi: 10.1177/2048872617703065

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2. 图 1 ROC分析结果。左边是房室传导阻滞患者的死亡预后模型，右边是窦房结无力综合征患者的预后模型（见正文）。

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