双心室再同步起搏治疗6例慢性充血性心力衰竭的近期疗效观察

Short-term curative effects of cardiac-resynchronization therapy in six cases of chronic congestive heart failure

目的观察双心室再同步起搏治疗难治性充血性心力衰竭患者的近期治疗效果。方法 6例心肌病并难治性充血性心力衰竭和心电图Q R S波时限大于120 m s的患者行双室再同步起搏治疗,术后随访6个月以上,观察左室电极起搏参数、Q R S波时限、左心室收缩末期内径、左心室舒张末期内径、左心室射血分数和6m in步行距离。结果 6例患者手术全部成功,1例于术后第3天死于脑梗死。其余5例随访6个月以上,患者左室电极的起搏阈值、阻抗及感知各参数值稳定,起搏功能良好;与术前相比Q R S波时限明显变窄;术后6个月心功能相关指标明显改善。结论双心室再同步化起搏是治疗伴心室间电机械不同步的顽固性心力衰竭患者的有效方法之一。

【Objective】 To observe the short-term curative effects of biventricular cardiac resynchronization therapy in patients of chronic congestive heart failure.【Methods】 Biventricular cardiac resynchronization therapy（CRT） underwent in six cases of primary dilated cardiomyopathy with chronic congestive heart failure and prolonged QRS duration（QRS duration≥120 ms）.During the 6 months of following-up period.The following parameters were recorded and analyzed： the pacing parameters of left ventricle electrode,the QRS wave width,left ventricular end-diastolic dimension（LVEDD）,left ventricular end-systolic dimension（LVESD）,left ventricular ejection fraction（LVEF）,6-minutes walking test（6 MWT）.【Results】 All of 6 cases were implanted CRT devices successfully.Except one case died from stroke three days after the operation,5 cases were completed the 6 months of follow-up.By the end of the 6th month after the operation,the pacing parameters of left ventricle electrode（the pacing voltage,the resistance and the sensitivity） are stable very much.Compared to before the operation,the width of QRS wave is obviously narrower,the LVEDD,LVESD and the LVEF were significantly improved,6 MWT was significantly increased.【Conclusion】 CRT is one of the effective therapies for the patients of chronic congestive heart failure accompanying electromechanical dissynchrony.