Clinical Comparison Of Left Ventricular Apex Septal Pacing And Basal Septal Pacing In The Transvenous Cross-Ventricular Septal Approach

BackgroundChronic Obsrtuctive Pulmonary Disease（COPD）is an incompletely reversible Chronic airway inflammatory Disease characterized by progressive decline in lung function.Effective prevention and treatment and management is the key to delay the continuous deterioration of COPD patients.If the disease is not effectively controlled during its occurrence,the patient’s quality of life will continue to decline with the gradual worsening of dyspnea,resulting in disability and even death.Several studies,including the2021 guidelines for the treatment of COPD,have suggested that multiple metabolic diseases often occur with COPD progression,of which hypocortisolemia（HC）is one of the comorbidities that occur at the end of COPD.According to statistics,elderly PATIENTS with end-stage COPD complicated with HC tend to increase the frequency of acute exacerbations and treatment difficulty,and improve the risk of death of patients.And because the common symptoms of HC can overlap with COPD,it has high stealth and low diagnosis rate in clinical practice.In the course of treatment,if the occurrence of HC is not recognized early and hormone intervention is given in time,the quality of life of patients will decrease,the economic burden will increase,and the fatality rate will increase.Therefore,this study aims to find the risk factors related to HC in elderly COPD and evaluate the predictive value of HC in elderly COPD,so as to improve the early warning awareness of HC in clinical work and reduce HC occurrence as much as possible,so as to improve the prognosis of elderly PATIENTS with COPD and improve the quality of life in the end stage.Research purposesTo find the risk factors for HC in elderly COPD patients,and evaluate the predictive efficacy of different risk factors for HC in elderly COPD patients.To demonstrate the need to evaluate HC in elderly patients with COPD.Research methodA total of 212 COPD patients hospitalized in Henan Provincial People’s Hospital from January 2020 to January 2021 were retrospectively collected.According to the inclusion and exclusion criteria,they were divided into the elderly COPD combined with HC group and the elderly COPD group.The contents between the two groups were compared respectively:（1）General information:gender,age,height,weight,history of systemic hormone therapy,complications,etc.Biochemical and auxiliary examinations:routine blood test,CRP,arterial blood gas analysis,thyroid function,lung function,etc.（3）The prognostic data at the end of follow-up included CAT score,m MRC score,the number of acute exacerbations within 1 year,the number of hospitalizations due to exacerbations within 1 year,and survival at 6 months and 1 year,etc.Statistical software was used to analyze the correlation between various factors and HC in elderly COPD patients,P<0.05 was statistically significant;Independent risk factors of binary Logistics regression analysis;ROC curve was used to analyze the efficacy of independent risk factors in predicting HC in elderly COPD.Research result（1）Spearman correlation analysis was conducted between serum COR（8am）and risk factors in 212patients.It was found that COR（8am）was negatively correlated with age,systemic hormone use history,CRP,PCO2 and Lac（P<0.05）,was positively correlated with FT3,FEV1%pred,PEF%pred（P<0.05）.（2）Binary Logistic regression analysis showed that age,history of systemic hormone therapy,Pa CO₂,FEV1%pred were independently correlated with elderly COPD complicated with HC（OR>1,P<0.05）,and the combined predictor was obtained by comprehensive calculation of the above 4 risk factors.Compared with single risk factor,the combined predictor was found to have the highest diagnostic efficiency.（3）At the end of follow-up,the risk of acute exacerbation in the elderly COPD combined with HC group was significantly higher than that in the elderly COPD group,and the six-month and one-year survival rates were lower than those in the elderly COPD group,P<0.05.In conclusionAge,systemic hormone use history,Pa CO2,FEV1%pred were independent risk factors for HC in elderly COPD patients,and the combined predictor had the highest diagnostic efficacy in predicting HC in elderly COPD patients.The risk of acute exacerbation and mortality of elderly COPD patients complicated with HC were significantly higher.