摘要目的 探讨血糖对永久性起搏器植入术患者首次植入起搏参数的影响。方法 选取2014年3月～2019年3月我院收治的231例植入永久性心脏起搏器患者作为研究对象进行回顾性分析，根据患者的血糖情况分为A组（糖尿病患者，42例）、B组（糖耐量异常患者，118例）和C组（血糖正常患者，71例）。比较三组患者的起搏阈值、感知、阻抗，起搏器参数程控测试时间，并分析血糖与起搏参数的相关性。结果 A组、B组患者心室的起搏阈值、感知、阻抗高于C组，参数程控测试时间长于C组，差异有统计学意义（P＜0.05）；A组与B组患者心室的起搏阈值、感知、阻抗比较，差异无统计学意义（P＞0.05）；A组患者的程控测试时间长于B组，差异有统计学意义（P＜0.05）；A组、B组患者的空腹血糖（FBG）和餐后2 h血糖（2 h BG）水平均高于C组，A组患者的FBG和2 h BG水平均高于B组，差异有统计学意义（P＜0.05）。Spearman相关性分析显示，FBG水平与起搏阈值、感知、阻抗以及参数程控测试时间成正相关（r=0.410、0.352、0.332、0.318，P＜0.05）；2 h BG水平与起搏阈值、感知、阻抗以及参数程控测试时间成正相关（r=0.425、0.367、0.346、0.327，P＜0.05）。结论 血糖对起搏器植入术患者起搏参数阈值、阻抗、感知有影响，血糖升高会导致起搏参数阈值、阻抗升高，感知灵敏度降低，起搏参数程控测试时间延长。
Abstract：Objective To investigate the effect of blood glucose on first implantation pacing parameters of patients undergoing permanent pacemaker implantation.Methods A total of 231 patients undergoing permanent pacemaker implantation treated in the hospital from March 2014 to March 2019 were selected as the subjects,and retrospective analysis was conducted.According to the blood glucose,they were divided into group A(patients with diabetes,42 cases),group B(patients with impaired glucose tolerance,118 cases)and group C(patients with normal blood glucose,71 cases).The pacing threshold,perception,impedance,program-controlled test time of pacemaker parameters were compared among the three groups.The correlation between blood glucose and pacing parameterswas analyzed.Results The ventricular pacing threshold,perception,impedance in group A and group B were higher than those in group C,and the program-controlled test time of parameters was longer than that in group C,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in ventricular pacing threshold,perception or impedance between the group A and group B(P＞0.05).The ventricular parameter programmable test time in group A was longer than that of group B,the difference was statistically significant(P＜0.05).The levels of fasting blood glucose(FBG)and blood glucose 2 hours aftermeal(2 h BG)in group A and group B were higher than those in group C,and the FBG and 2 h BG levels of group A were higher than those of group B,the differences were statistically significant(P＜0.05).Spearman correlation analysis showed that FBG was positively correlated with pacing threshold,perception,impedance and program-controlled test time of parameters(r=0.410,0.352,0.332,0.318;P＜0.05).And 2 h BG was positively correlated with the pacing threshold,perception,impedance and program-controlled test time of parameters(r=0.425,0.367,0.346,0.327;P＜0.05).Conclusion Blood glucose has influence on the pacing threshold,impedance and perception of patients undergoing pacemaker implantation.High blood glucose will lead to elevated pacing threshold and impedance,decreased sensitivity and prolongation of program-controlled test time of parameters.
Li G，Zhang P，Wang J，et al.Cardiovascular mortality，allcausemortality，and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study：a 23-year follow-up study[J].Lancet Diabetes Endocrinol，2014，2（6）：474-480.
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