慢性心力衰竭植入器械治疗新进展

New progress of mechanotherapy in chronic heart failure

慢性心力衰竭是临床发病率很高的心血管疾病之一,目前应用植入型心律转复除颤器(ICD)预防猝死的发生,"金三角"醛固酮受体拮抗剂、β受体阻滞剂、ACEI/ARB等药物与心脏再同步化治疗起搏器(CRT)等器械联合应用均取得良好效果。但就现有研究表明ICD的应用并没有改善心脏功能或症状,而植入CRT治疗的患者选择比较严格,部分患者无法植入满意位置或植入后存在CRT无应答,并且CRT不能改善有正常或轻度延长QRS间期的、有中度收缩功能障碍的患者。针对此局限性,近年来出现许多新的器械治疗方式为器械治疗心衰带来新的曙光,如心肌收缩调制术、左心室隔离装置、肾脏去神经术及脊髓神经刺激疗法等。本文旨在归纳心力衰竭现有器械植入状况,及对其最新进展进行较为全面的阐述。

Chronic heart failure is one of the most common clinical cardiovascular disease with high incidence. Implantable cardioverter defibrillator （ICD） is applied to prevent sudden death occurred. The combined application of medicine such as ACEI/ARB, aldosterone antagonists and beta blockers with equipment such as cardiac resynchronization therapy （CRT） have achieved good results. But the existing research shows that the application of ICD did not improve cardiac function, and CRT treated patients being chose is strict, and some patients are unable to implant properly or get no response after implantation of CRT. And CRT does not improve patients with normal or mild prolongation of the QRS interval and moderate systolic dysfunction. However, in recent years, many new devices bring a new dawn, such as cardiac con- tractility modulation （CCM）, left ventricular isolation device, denervation of kidney, spinal nerve stimulation therapy and so on. The purpose of this paper is to summarize the present situation of the existing device implantation of heart failure, and to make a comprehensive exposition of its recent progress.