双心室再同步化起搏治疗慢性充血性心力衰竭临床应用

Efficacy of cardiac resynchronization therapy for treating patients with chronic heart disease

目的通过对具有心脏再同步化治疗（CRT）或埋藏式三腔起搏除颤器（CRTD）植入适应证的患者进行CRT或CRTD植入治疗,从而分析研究CRT或CRTD对慢性严重充血性心力衰竭或伴致死性心律失常的慢性严重充血性心力衰竭患者的疗效。方法对2005年10月至2009年6月玉溪市人民医院收治的慢性严重充血性心力衰竭或伴致死性心律失常患者22例,其中缺血性心肌病12例,扩张型心肌病9例,肥厚性心肌病1例,均按照心力衰竭治疗指南使用最佳药物治疗方案,反复治疗后疗效不佳,符合CRT或CRTD植入适应证,植入CRT或CRTD。结果所有患者植入手术均获成功。术后随访2-41个月。1例患者术后因全身衰竭死亡。其余患者同时按照心力衰竭治疗指南使用与术前相同的最佳药物治疗心力衰竭,左心室射血分数（LVEF）术前（33.08±5.99）%,术后（45.17±7.47）%,较术前明显提高（P〈0.01）。运动耐量6分钟步行距离术前（315.39±21.32）m,术后（426.28±72.52）m,术后较术前明显提高（P〈0.01）。左心室舒张末内径（LVEDD）术前（67.59±8.38）mm,术后（64.60±8.92）mm,术后较术前有所减少,但差异无统计学意义（P〉0.05）。所有患者心功能分级从术前Ⅲ-Ⅳ级改善为术后Ⅰ-Ⅲ级。结论 CRT或CRTD能改善心力衰竭患者的心功能及生活质量等,可以使患者长期获益。CRTD可以通过预防心力衰竭患者恶性心律失常,从而减少病死率。

Objective To implant cardiac resynchronization therapy（CRT） or cardiac resynchronization therapy-defibrillators（CRTD） in the patients with indications of implantation,then analyze and investgate the efficacy of CRT or CRTD to the patients who had severe congestive heart failure or fatal arrhythmia associated with chronic severe congestive heart failure.Methods From October 2005 to January 2009,People＇s Hospital of Yuxi treated 22 patients who had chronic severe congestive heart failure or were associated with fatal arrhythmia,12 cases of ischemic cardiomyopathy,9 cases of dilated cardiomyopathy,1 case of hypertrophic cardiomyopathy.According to the heart failure treatment guidelines in the use of the best drug treatment program,the treatment efficacy was still poor,the patients conformed to CRT or CRTD implanted indications.Results All patients were successfully implanted.Follow-up postoperative observation for 2-41 months.Just 1 patient died of systemic failure after operation.The remaining patients were in accordance with treatment guidelines for heart failure and using the best medical treatment for heart failure as preoperative therapy,LVEF（%） was improved from（33.08±5.99）% to（45.17±7.47）%（P〈0.01）;exercise tolerance 6 minutes walking distance was improved from（315.39±21.32） m to（426.28±72.52） m（P〈0.01）,LVEDD was reduced from（67.59±8.38） mm to（64.60±8.92） mm（P〈0.05）;the cardiac function classification of 21 patients were all changed from preoperative Ⅲ-Ⅳ grades to postoperative Ⅰ-Ⅲ grades.Conclusion CRT or CRTD could improve cardiac function and the life quality of patients with severe heart failure and make a long-term benefit for patients.CRTD could prevent malignant ventricular arrhythmia of patients with heart failure and reduce the incidence of mortality.