心脏再同步化治疗顽固性心力衰竭临床分析

Clinical Analysis of Cardiac Resynchronization Therapy in Intractable Heart Failure

目的观察心脏再同步化治疗(CRT)对顽固性心力衰竭患者心功能的影响。方法对6例符合CRT适应证的顽固性心力衰竭患者植入三腔型起搏器,进行三腔起搏或双心室起搏,使心室间收缩趋向同步化。6例患者均成功植入了起搏器,左室电极植入位置4例位于心室后侧静脉,2例位于心室前侧静脉。结果术后3、6个月患者的胸闷气促症状明显改善,生活能够自理,心功能改善Ⅰ级,QRS宽度均较术前缩短,左室射血分数提高,左室舒张末期内径减小,二尖瓣反流程度减轻,心胸比缩小。结论 CRT通过改善心室收缩的同步性、提高左室射血分数,从而改善心功能、提高生活质量和运动能力。

Objective To observe the effects on cardiac function of cardiac resynchronization therapy（CRT） in patients with refractory heart failure. Methods In order to synchronously contract inter-ventricular,we implanted three chamber pacemaker in six cases with refractory heart failure conforming to indications of CRT and conducted three-chamber pacing or biventricular pacing. 6 patients were successfully implanted pacemakers,four cases of which the left ventricular electrode was implanted in ventricular posterior vein,the other two cases of which was in the ventricular anterior interventricular vein. Results After 3 to 6 months, symptoms of chest tightness and shortness of breath have significantly improved,quatity of life improved,heart function improved class I ,QRS width shorter than that of preopera^e,left ventricular ejection fraction improved,left ventricular end-diastolic diameter reduced,degree of mitral valve counter-flow redueed,cardiothoraeic ratio reduced. Conclusion By improving the synchronization of ventricular contraction,CRT increased left ventricular ejection fraction,thereby improve cardiac function and quality of life and athletic ability.