CRT和药物治疗对扩张型心肌病患者心功能影响的临床对比研究

Clinical study on effect of CRT and drug treatment on heart function in patients with dilated cardiomyopathy

目的探讨心脏再同步化起搏治疗(Cardiac resynchronization therapy,CRT)与药物治疗对扩张型心肌病(Dilat edcardio myopathy,DCM)伴慢性心力衰竭患者心功能影响的差异。方法选取1998年2月至2014年1月我院收治的DCM伴有慢性心力衰竭患者20例,作为观察组,在抗心衰药物治疗基础上,心衰仍不能纠正,且符合CRT治疗指征行CRT起搏治疗;对照组20例,为同期住院的DCM伴有心力衰竭患者,使用常规抗心衰药物治疗,包括ARB、ACEI类改善心肌重构、利尿剂、β受体阻滞剂、洋地黄等治疗。对比两组患者治疗后(术后)6月、治疗后(术后)12月心脏超声参数:左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)及血脑钠肽(BNP)含量,以评价治疗后心功能的差异。结果观察组较对照组比较,治疗后(术后)6月LAD变化不明显,差异无统计学意义(P>0.05);LVEDD、LVESD较对照组明显缩小,LVEF则明显提高,BNP显著降低,差异有统计学意义(P<0.05);治疗后(术后)12月两组比较LAD、LVEDD、LVESD无明显差异,BNP未见明显降低,差异无统计学意义(P>0.05)。结论 CRT起搏治疗可改善DCM伴有慢性心力衰竭患者心功能,但长期CRT起搏治疗并不优于药物治疗,药物治疗仍是DCM伴有慢性心力衰竭患者治疗的基础。

Objective To study the cardiac resynchronization therapy（ Cardiac resynchronization therapy,CRT） and drug therapy in patients with dilated cardiomyopathy（ Dilatedcardio myopathy,DCM）difference with cardiac function in patients with chronic heart failure. Methods 20 patients with chronic heart failure from 1998 DCM February to 2014 January in our hospital were cases,as the observation group,the anti heart failure drug therapy,heart failure was still not correct,and in accordance with CRT treatment indication for CRT pacing therapy; the control group of 20 cases,for the same period in expanding DCM with heart failure patients,treatment conventional anti heart failure drug used,including ARB,ACEI and improved myocardial remodeling,diuretics,beta blockers,digitalis therapy. The two groups were compared after treatment（ after June）,after treatment（ after December） echocardiography parameters： left atrial diameter（ LAD）, left ventricular end diastolic diameter（ LVEDD）,left ventricular end systolic diameter（ LVESD）,left ventricular ejection fraction（ LVEF） and serum BNP content,differences in the heart functional evaluation after treatment.Results Compared the observation group with the control group,after treatment（ after June） of LAD did not change significantly, the difference was not statistically significant（ P 〉0. 05）; LVEDD, LVESD were significantly decreased,LVEF increased,BNP decreased,the difference was statistically significant（ P〈 0. 05）;after treatment（ after December） of two groups comparison of LAD,LVEDD,LVESD had no significant difference,BNP has not decreased,no significant difference（ P 〉0. 05）. Conclusions CRT pacing can improve heart function in patients with chronic heart failure associated with DCM,but the long-term CRT pacing therapy is not superior to drug therapy,drug therapy is still the foundation with DCM in patients with chronic heart failure treatment.