慢性心力衰竭心脏再同步化治疗10例经验

Biventricular Resynchronization Therapy of Chronic Heart Failure

目的:观察双心室起搏心脏再同步化治疗对慢性心力衰竭患者的治疗效果。方法:选取10例慢性心力衰竭伴室内传导阻滞患者进行双心室起搏心脏再同步化治疗。观察术前、术后3个月和术后6个月的NYHA心功能分级、QRS时限、左心室射血分数(LVEF)、左心室舒张末内径(LVEDD)、二尖瓣反流量(MR)和6分钟步行试验的变化。结果:10例患者顺利完成三腔起搏器(美敦力)植入术,均未发生严重并发症。平均放射时间为(42.3±20.2)min。双心室再同步化治疗后,患者NYHA心功能分级由术前(3.7±0.5)改善为(2.5±0.5)(术后3个月)和(2.4±0.5)(术后6个月),P均<0.05;QRS时限由术前(152.8±25.5)ms减少到(122.2±22.4)ms(术后3个月)和(119.1±20.8)ms(术后6个月),P均<0.05;LVEF由术前(0.28±0.06)增加到(0.44±0.09)(术后3个月)和(0.45±0.12)(术后6个月),P均<0.05;LVEDD由术前(70.5±8.3)mm减少到(64.8±8.6)mm(术后3个月,P>0.05)和(61.5±10.4)mm(术后6个月,P<0.05);MR由术前(27.8±13.6)ml减少到(16.3±9.1)ml(术后3个月)和(10.7±9.4)ml(术后6个月),P均<0.05;6分钟步行试验由术前(174.6±123.7)m增加到(329.7±118.9)m(术后3个月)和(446.2±184.1)m(术后6个月),P均<0.05。LVEF与6分钟步行试验呈正相关(r=0.636,P<0.05)。结论:双心室起搏心脏再同步化治疗可明显改善慢性心力衰竭伴心室内传导延迟患者的血流动力学、心功能和心力衰竭的临床症状,提高患者的生活质量。

Objective：To assess the therapeutic effects of resynchronous biventricular pacing on drug-refractory chronic heart failure. Methods：A total of 10 patients with chronic heart failure accompanied by intraventricular conduction delay were selected to receive resynchronous biventricular pacing. Changes of NYHA functional class, QRS duration, left ventricular ejection fraction （LVEF） ,left ventricular end diastolic diameter （ LVEDD ）, mitral regurgitation （ MR ） and 6 minutes walk distance （ 6 MWD ） were observed before and 3, 6 months after implantation. Results： Insync Ⅲ devices（Medtronic） were successfully implanted without major complications in 10 patients. The fluoroscopy time was 42. 3 ± 20, 2 min. Three and six months after implantation, NYHA functional class was obviously improved to 2.5±0.5 and 2.4 ±0.5 from 3.7 ±0.5. QRS duration was obviously decreased to 122.2 ±22.4 ms and 119. 1 ±20.8 ms from 152. 8 ± 25.5 ms. LVEF was obviously increased to 0. 44 ± 0.09 and 0. 45 ± 0. 12 from 0. 28 ± 0. 06. LVEDD was decreased to 64. 8 ± 8. 6 mm（ P 〉 0. 05 ） and 61.5 ± 10. 8 mm （P 〈 0. 05 ） from 70. 5 ± 8. 3 mm. MR was obviously decreased to 16. 3 ± 9. 1 ml and 10, 7 ±9. 4 ml from 27.8 ± 13.6 ml, Six MWD was obviously increased to 329. 7 ± 118. 9 m and 446. 2± 184. 1 m from 174. 6 ± 123. 7 m（P 〈 0. 05 ）, LVEF was significantly positively correlated with 6 MWD. Conclusion ： Resynehronous biventricular pacing can improve hemodynamics, cardiac function, clinical symptoms and quality-of-life in patients with chronic heart failure.