慢性心力衰竭患者双室起搏即刻血压变化及其临床意义

The clinical significance of instant changes of blood pressure after biventricular pacing in patients with chronic heart failure

目的:观察慢性心力衰竭患者双室起搏即刻有创血压变化及探讨其临床意义。方法:入选慢性心力衰竭患者27例,其中缺血性心肌病(ICM)9例(ICM组),扩张型心肌病(DCM)18例(DCM组)。所有患者均成功植入三腔起搏器。术中记录双室起搏前后的心电图及有创血压,并测量双室起搏前后QRS波时限。观察两组患者对双室起搏反应的差异。结果:①双室起搏即刻所有患者收缩压和舒张压均升高(P<0.05),QRS波时限均缩短(P<0.05);②双室起搏即刻患者血压升高水平与左室舒张末内经、左室舒张末容积、QRS波时限缩短程度、起搏时QRS波时限及NYHA心功能水平相关(P<0.05);③术后即刻DCM组患者在收缩压升高水平和QRS波时限缩短程度方面较ICM组显著(P<0.05);④多元逐步回归分析显示CRT-P/D术中双室起搏即刻收缩压升高程度与心功能和起搏即刻QRS波时限缩短程度显著相关(P<0.05)。结论:慢性心力衰竭患者双室起搏即刻血压改善与急性期心脏再同步改善相关。

Objective： To observe the instant changes of blood pressure in patients with chronic heart failure after biventricular pacing and explore its clinical significance. Methods： Twenty-seven cases with chronic heart failure were enrolled,including 9 cases with ischemic cardiomyopathy （ICM group）and 18 cases with dilated cardiomyopathy（ DCM group）. All patients were success fully implanted with three chamber pacemaker. Electrocardiogram and blood pressure were recorded before and after biventricular pacing in the process of operation. QRS duration before and after biventricular pacing and the response to biventricular pacing between the two groups were observed. Results： After biventricular pacing, the systolic blood pressure（SBP） and diastolic blood pressure（DBP） of all the patients was elevated （P 〈 0.05 ） , and QRS duration was reduced （P 〈 0.05）. The elevated SBP was related to LVEDD, LVEDV, shortened QRS duration, pacing QRS duration and NYHA cardiac function （P 〈0.05）. Compared with the ICM group, SBP increased much higher and QRS duration shortened much greater in DCM group. Stepwise multiple regression analysis showed that the instant increase of SBP was significantly associated with shortened QRS duration and NYHA cardiac function （P 〈 0.05）. Conclusion ： After biventricular pacing, instant improvement of blood pressure of patients with chronic heart failure is associated with acute cardiac resynchronization improvement.