双心室同步起搏治疗难治性心力衰竭的长期临床疗效Long-term outcome of cardiac resynchronization therapy in patients with drug-refractory heart failure
汪芳,金炜,张建军,孟伟栋,庄文燕,薛吉祥,孙宝贵
摘要(Abstract)：
目的探讨心脏同步化治疗(CRT)对于药物难治性慢性心力衰竭的效果。方法回顾性分析我院自1999年以来48例药物治疗无效的顽固性心力衰竭患者的临床资料,其中男性40例,女性8例,年龄48~84(70.0±18.5)岁。其心力衰竭的NYHA分级为Ⅲ~Ⅳ级,左心室射血分数(LVEF)≤35%,QRS间期≥130ms,左心室舒张末内径(LVEDd)≥60mm。在CRT治疗后平均随访时间(29.0±7.5)个月。采用心电图观察QRS时限、超声心动图计算LVEF,组织多普勒了解心室壁同步的情况;6min步行距离测量心脏的负荷能力的变化。结果(1)QRS时限起搏前(188±40)ms、右心室起搏(222±34)ms、左心室起搏(212±42)ms、双心室起搏(169±26)ms,双心室起搏和起搏前、右心室起搏、左心室起搏比较QRS时限明显缩短(P<0.05)。(2)心功能分级(NYHA)术前Ⅲ~Ⅳ级,术后1周Ⅰ~Ⅱ级,术后1个月直至随访时仍旧Ⅰ~Ⅱ级。(3)LVEF术前(28.30±3.94)%,术后1周(37.80±3.98)%,随访结束时(41.67±6.77)%,术后1周和术前比较明显提高(P<0.05),随访时和术前比较亦明显提高(P<0.05),但是随访时和手术后1周比较差异无统计学意义。(4)6min步行距离术前(398±168)m,术后1周(478±126)m,随访时增加至(506±134)m,术后1周和术前比较有明显提高(P<0.05),随访时和术前比较亦明显提高(P<0.05),随访时和手术后1周比较也明显提高(P<0.05)。1例患者在CRT治疗后1年行心脏移植。共计6例患者死亡。结论CRT短期就可以减轻药物难治性慢性心力衰竭患者的症状,增加其运动能力,改善心脏功能,可以使患者长期获益。
关键词(KeyWords)： 心脏起搏,人工;心力衰竭,充血性;治疗结果
基金项目(Foundation):
作者(Author): 汪芳,金炜,张建军,孟伟栋,庄文燕,薛吉祥,孙宝贵
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