心室再同步心脏转复除颤器的临床应用及疗效分析

The clinical application and therapeutic effects of cardiac resynchronous therapy with defibrillator

目的观察心室再同步心脏转复除颤器(CRT-D)对慢性心力衰竭合并恶性室性心律失常患者的疗效。方法9例均为男性,心功能(NYHA分级)Ⅲ～Ⅳ级,ORS波时限>130ms,左室舒张末期内径>60mm,左室射血分数(LVEF)<0.35伴二尖瓣返流,均有恶性室性心律失常发作病史。观察患者CRT-D置入前,置入后1,3,6,12,24及36个月的心功能各项参数变化、生活质量(QOL)评分以及并发症、心血管事件。结果随访22.6±6.7(13～35)个月,发生术中心力衰竭加重和术后电极脱位并发症各1例;CRT-D治疗期间无死亡,LVEF、心功能NY-HA分级等心功能评价指标术后持续改善,QOL评分较术前明显提高,3例发生12次室性心动过速/心室颤动均被CRT-D成功纠治。结论CRT-D能明显改善慢性心力衰竭患者的心功能,提高生活质量,降低心力衰竭导致的病死率;同时还可防治心脏性猝死。

Objective To study the therapeutic effects of cardiac resynchronous therapy with defibrillator（CRT-D） in chronic heart failure and lethal ventricular arrhythmias. Method A number of 9 male were enrolled. They were all with heart failure of New York Heart Association（NYHA） functional class m or IV, QRS duration 〉 130 ms, left ventricular end-diastolic dimension 〉 60 mm, left ventricular ejection fraction（LVEF） 〈 0.35 and mitral regurgitation as well as lethal ventricular arrhythmias[ ventricular tachycardia（VT）/ventricular fibrillation（VF） J. All of them were attempted to implant CRT-D. Heart function parameters, quality of life score and complications coupled with cardiac incidents were meas- ured and observed before and after 1 month, 3, 6, 12, 24, 36 months ＂after CRT-D implantation. Results In the followup period of 13 - 35 （ average follow-up of 22.6 ± 6.7 ） months, 1 case of electrode dislocation after implantation and 1 case of advanced heart failure during implantation occurred; There was no death; The heart function parameters such as LVEF, NYHA class, were being improved after implantation; The grade of QOL increased significantly; 3 patients had 12 VT/VF episodes which were successfully terminated by the device. Conclusion CRT-D can enhance the heart function of chronic heart failure and the quality of life, as well as reduce the mortality of heart failure. The device can also be effective in preventing sudden cardiac death.