心脏再同步治疗慢性心力衰竭患者的疗效观察

Clinical observation of resynchronization therapy for patients with chronic heart failure

目的观察双心室再同步起搏治疗慢性心力衰竭(CHF)的临床疗效。方法35例慢性心力衰竭合并室内阻滞患者,其中男性26例,女性9例,年龄32～76(65.4±12.3)岁,行双心室再同步起搏治疗(CRT),全部患者均经冠状静脉窦植入左心室导线1根至心脏静脉。术后平均随访5～42(21.6±8.3)个月,观察心功能,QRS波宽度,左心室收缩、舒张末内径,左心室射血分数,二尖瓣反流面积,6min步行距离。结果28例治疗后心功能改善,有效率80%,心功能从Ⅲ～Ⅳ级(NYHA分级)改善为Ⅱ～Ⅲ级,QRS波从(165±48)ms缩短至(135±50)ms,(P<0.01),6min步行距离从(389±175)m提高至(512±145)m,(P<0.01),左心室舒张末内径、收缩末内径分别从(75.4±9.5)mm,(65.5±9.2)mm缩小至(66.4±8.5)mm和(58.2±10.5)mm,(P<0.01),左心室射血分数从0.24±0.08提高至0.33±0.10,(P<0.01),二尖瓣反流面积从(9.12±3.25)cm2减少至(5.12±1.82)cm2,(P<0.01)。随访中6例死亡(2例心性猝死、2例非心源性死亡、1例急性心肌梗死、1例心力衰竭恶化)。结论CRT是慢性心力衰竭治疗的有效方法,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。

Objective To observe the clinical effect of biventricular pacing in patients with chronic heart failure. Methods The study comprised a total of 35 patients （mean age 65.4±12.3 years old, male 26 and female 9 ） with chronic heart failure and left bundle branch block, who received biventricular resynchronous pacing, and left ventricle leads were implanted into one of cardiac veins. The outcome of CRT was evaluated in terms of QRS duration, left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVDd）, left ventricular end-systolic diameter （LVSd）, mitral regurgitation （MR） through echocardiography, 6-minute hall walk and the NYHA heart function class. Results The heart function of 28 patients was significantly improved after the treatment（80%）.The NYHA heart function class of the patients was improved from class Ⅲ -Ⅳ to class Ⅱ - Ⅲ .The QRS width was reduced from（165±48） ms to （135±50） ms（P〈 0.01）. LVDd was decreased from （75.4±9.5）mm to （66.4±8.5） mm（P〈 0.01）. LVSd was decreased from （65.5±9.2） mm to （ 58.2±10.5）mm （P 〈 0.01）. LVEF was increased from 0.24±0.08 to 0.33 ± 0.10（P〈 0.01）. MR was diminished from （9.12 ± 3.25） cm^2 to （5.12 ± 1.82） cm^2 （P〈 0.01）. 6 patients died during follow-up （2 sudden cardiac death, 2 non-cardiogenic cause, 1 acute myocardial infarction and 1 aggravation of heart failure）.Conclusions CRT improves symptoms , the quality of life , heart function and ability of exercise in patients with advanced heart failure by improving ventricular synchrony. CRT is an effective treatment for chronic heart failure.