心脏再同步化治疗慢性顽固性心力衰竭6例

Cardiac biventricular resynchronization therapy of chronic refractory heart failure

目的观察双室起搏心脏再同步化治疗(CRT)对慢性顽固性心力衰竭的效果。方法选取6例慢性顽固性心力衰竭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6min步行试验的变化。结果6例患者顺利完成三腔双心室起搏器植入术,均未发生严重并发症。双心室再同步化治疗后的第3个月和第6个月,患者NYHA心功能分级由术前(3.7±0.5)改善为(2.6±0.5)、(2.2±0.6),P均<0.05;QRS时限由术前(150.8±21.5)ms减少到(120.2±21.4)m、(118.6±20.2)ms,P均<0.05;LVEF由术前(0.28±0.06)增加到(0.46±0.08)、(0.51±0.10),P均<0.05;LVEDD由术前(70.5±8.3)mm减少到(64.6±8.1)mm、(61.8±10.2)mm,P<0.05);MR由术前(27.8±13.6)ml减少到(16.7±8.7)ml、(10.9±9.2)ml,P<0.05;6min步行试验由术前(170.6±123.7)m增加到(326.8±112.4)m、(440.2±172.1)m,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顽固性心力衰竭患者的血流动力学、心功能和心力衰竭的临床症状,提高患者的生活质量。

Objective To appraise the therapeutic effects of resynchronous biventricular pacing on refractory chronic heart failure.Methods 6 patients with chronic refractory 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）,lefl ventricular end diastolic diameter （LVEDD）,mitral regurgitation（MR）and 6 minutes walk distance（6MWD）were observed before and 3,6 months after implantation.Results Three and sixmonths after implautation,NYHA functional class was obviously improved to 2.6±0.5 and 2.2±0.6 from 3.7±0.5.QRS duration was obviously decreased to 120.2±21.4 ms and 118.6±20.2ms from 150.8± 21.5ms. LVEF was obviously increased to 0.46±0.08 and 0.51±0.10 from 0.28±0.06.LVEDD was decreased to 64.6±8.1mm and 61.8 ±10.2mm （P〈0.05） .from 70.5±8.3mm.MR was obviously decreased to 16.7 ±8.7ml and 10.9 ±9.2ml from 27.8 ±13.6 ml.Six MWD was obviously increased to 326.8±112.4m and 440.2±172.1m from 170.6±123.7m （P〈0.05）.Conclusion Resynchronous biventricular pacing can improve hemodynamics,cardiac function, clinical symptoms and quality of life in patients with chronic refractory heart failure.