心脏同步化治疗慢性心力衰竭疗效及临床经验总结

Effects and experience summary of resynchronization therapy in patients with chronic heart failure

目的总结心脏同步化起搏治疗慢性心力衰竭的疗效及临床经验。方法回顾性分析接受再同步化治疗的26例慢性心力衰竭伴心室内传导延迟患者的临床资料,着重分析再同步化治疗的方法和疗效。结果患者均接受心脏再同步化治疗,年龄(57.0±11.6)岁,男22例(84.6%,22/26),其中再同步化转复除颤器16例(62%,16/26),非缺血性心肌病22例(85%,22/26),9例(35%,9/26)有慢性房性心律失常,2例需外科植入左心室心外膜电极。心脏再同步化治疗后QRS波时限由(161±29)ms缩短为(137±15)ms,差异有统计学意义(P≤0.01);患者心功能均有明显改善,心功能分级比治疗前降低,差异有统计学意义[(1.9±0.9)级vs.(3.2±0.6)级,P≤0.01];射血分数比治疗前提高,差异有统计学意义(34.0%±13.3%vs.24.9%±6.8%,P≤0.01)。6分钟步行距离、血清脑钠肽浓度以及左心室舒张或收缩末内径均有显著改善(P≤0.05)。术后随访(2.5±1.7)年,7例(27%,7/26)死亡,其中2例心源性猝死。结论心脏同步化起搏治疗显著改善慢性心力衰竭患者心功能,逆转心肌重构,减低病死率。

Objectives To evaluate the effects and summarize the experiences of cardiac resynchronization therapy（CRT） in patients with chronic heart failure（CHF）.Methods Review the clinical data of 26 consecutive patients with CHF and interventricular conduction delay receiving CRT in our centre.Results All 26 patients received CRT devices with most having ischemic cardiomyopathy [16 patients received an combined implantable cardioverter-defibrillators（ICDs）].All left ventricular leads were implanted by conventional transvenous method except 2 by thansthorasic surgery.The average age was（57.0±11.6） years old and most being male（84.6%,22/26）.There were 22（85%,22/26） patients with on-ischemic cardiomyopathy and 9 patients（35%,9/26） with chronic atrial arrhythmia.Two patients received appropriate ICD therapy and an extra 2 received inappropriate therapy.QRS duration[（161±29） ms vs.（137±15） ms,P≤0.01],New York Heart Association heart function class[（1.9±0.9）grade vs.（3.2±0.6） grade,P≤0.01] and ejection fraction（34.0%±13.3% vs.24.9%±6.8%,P≤0.01） were improved after CRT.Improvement of 6-minute walk distance,atrial natriuretic peptide and end diastolic/systolic diameter also showed significance（P≤0.05）.During an average follow-up of 2.5±1.7 years,7（27%） patients died with 2 died suddenly.Conclusions CRT or combined with ICD could improve heart function,reverse myocardial remodeling and decrease mortality in patients with chronic heart failure and intraventricular conduction delay.