心脏再同步化治疗患者术后反应的比较研究

Pharmacological treatment in patients with cardiac resynchronization therapy

目的回顾分析心脏再同步化治疗（CRT）患者抗心衰药物的治疗变化，指导术后规范用药。方法选取102例CRT治疗患者随访数据，根据术前和末次随访记录的左室舒张末期内径（LVEDD），左心室射血分数（LVEF）和纽约心功能分级（NYHA）将患者分为有反应组和无反应组；分析两组的血管紧张素转换酶抑制剂／血管紧张素受体拮抗剂（ACEI／ARB）、β受体阻滞剂、利尿剂和地高辛等药物使用变化情况。结果86例患者归入有反应组，16例患者归入无反应组。有反应组术后ACEI／ARB应用剂量明显增加（84比56），β受体阻滞剂也明显增加（86比60），利尿剂无明显变化（85比80），地高辛也无明显变化（82比81）；无反应组术后A—CEI／ARB应用剂量患者明显减少（13比4），β受体阻滞剂量也明显减少（10比5），利尿剂无明显变化（16比16），地高辛也无明显变化（15比16）。ACEI／ARB＋β受体阻滞剂剂量均增加组和单药组比较，NYHA心功能分级改善、LVEDD缩小及LVEF提高更为显著。结论慢性充血性心力衰竭患者CRT术后应及时调整药物治疗方案，CRT治疗能提高抗心衰药物的效果。

Objective To investigate anti-heart failure pharmacologic treatment in patients with cardiac resynchronization therapy. Methods The clinical data of 102 patients undergoing cardiac resynchronization therapy were retrospectively analyzed. Patients were divided into response group and non-response group. The dosage of anti-heart failure drugs, the NYHA class, left ventricular ejection fraction （LVEF） and left ventricular end diastolic diameter （LVEDD） were compared between two groups. Results There were 86 patients in response group and 16 patients in non-response group. Dosage of ACEI/ARB, beta blockers, diuretics and digoxin in response group were all increased. Patients assigned to ACEI ＋beta blockers with increasing-dose group experienced a greater improvement in NYHA class, LVEF and LVEDD than those in non-drug group. Conclusion CRT can improve effectiveness of drug therapy in patients with chronic congestive heart failure; meanwhile the drug dosage need to be adjusted after CRT.