心脏再同步治疗慢性心力衰竭患者的并发症分析

Analyses of complications for cardiac resynchronization therapy on patients with chronic heart failure

目的 探讨心脏再同步治疗（CRT）慢性心力衰竭患者的术中、术后并发症的发生与处理措施。方法 CRT植入术者55例，男性38例，女性17例，年龄（62．5±9．6）岁，其中扩张性心肌病（DCM）41例，缺血性心肌病（CHD）11例，Ⅲ度房室传导阻滞伴心脏扩大2例，致密化不全性心肌病1例。NYHA心功能分级均为Ⅲ级-Ⅳ级。均成功植入三腔起搏器。术后常规应用标准抗心力衰竭药物，随访2—60（24．9±15．5）个月，观察术中、术后并发症的发生情况及处理效果。结果 55例患者中左室电极置入失败1例（1．8％），发生电极导线脱位3例（5．5％），膈肌刺激2例（3．6％），术中急性左心力衰竭竭1例（1．8％），血管迷走反射（VVR）1例（1．8％），均妥善处置，未发生恶性结果。结论 CRT植入术术中和术后有可能出现各种并发症，以电极导线脱位最常见；针对不同的情况妥善处理才能充分发挥CRT在心力衰竭治疗中的作用。

Objective To analyze the complications for cardiac resynchronization therapy in patients with chronic heart failure. Methods Fifty five patients （38 men and 17 women, mean age 62.5 ± 9.6 years） with New York Heart Association （NYHA） class Ⅲ-Ⅳ received cardiac resynchronization therapy. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 41, ischemic myocardiopathy in Ⅱ, Ⅲ °atrioventricular block associated with enlarged heart in 2 and noncompaction of ventricular myocardium in 1. Patients who were implanted biventricular pacemakers were evaluated at 1,3,6,9,12 months and every six months thereafter. The mean duration of follow-up was 24.9 ± 15.5 months. Results There were 1 case （ 1.8% ） of unsuccessful left ventricular lead implant,3 cases （ 5.5 % ） of pacemaker lead displacement,2 case （3.6%） of coronary sinus dissection, 1 case （ 1.8% ） of pulmonary air embolism, 1 case （ 1.8% ） of pacemaker pocket complication, 2 cases （ 3.6% ） of diaphragmatic stimulation, 1 case （ 1.9% ） of vasovagal reflex, 1 case （ 1.9% ） of acute left heart failure. None of patients died. Conclusions There were some risk in the procedure of implanting biventricular pacing system. The complications related to CRT should be reduced by all means.