心力衰竭患者希氏束起搏的疗效和安全性

Efficacy and safety of His bundle pacing in patients with heart failure

目的探讨希氏束起搏(His bundle pacing,HBP)治疗心力衰竭的临床效果和安全性。方法回顾性分析2012年4月至2016年6月于本院行起搏器植入术的39例心力衰竭患者的临床资料,根据心脏起搏治疗方案不同将其分为HBP组(16例)和右室心尖部起搏(right ventricular apex pacing,RVAP)组(23例),记录并比较两组患者的一般资料、起搏器植入时和术后2年的起搏器植入参数、术前和术后2年的心功能参数以及术后并发症发生情况。结果 HBP组患者手术时间显著长于RVAP组(P <0.05)。术后2年,HBP组患者起搏器阻抗显著低于同期RVAP组和本组起搏器植入时的水平(P_均<0.05),QRS时限显著短于RVAP组(P <0.05),左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左室射血分数(left ventricular ejection fraction,LVEF)、6 min步行测试(6 minute walking test,6MWD)距离均显著大于RVAP组(P_均<0.05)。HBP组患者术后2年的QRS时限、LVEF、6MWD距离与术前比较均具有显著差异(P_均<0.05)。RVAP组患者术后2年的QRS时限、LVEDD、6MWD距离与术前比较均具有显著差异(P_均<0.05)。两组患者术后并发症发生率比较无显著差异(P> 0.05)。结论 HBP可保证植入心脏起搏器的心力衰竭患者心室同步性收缩,改善心脏功能。

Objective To investigate the clinical efficacy and safety of His bundle pacing(HBP)in the treatment of heart failure.Method The clinical data of 39 patients who underwent pacemaker implantation in our hospital from April 2012 to June 2016 for heart failure were analyzed retrospectively,according to the different cardiac pacing treatment schemes,they were divided into HBP group(n=16)and right ventricular apex pacing(RVAP)group(n=23).The general data,pacemaker implantation parameters at the time of pacemaker implantation and 2 years after operation,cardiac function parameters before and 2 years after operation,postoperative complications were recorded and compared between the two groups.Result The operation time of HBP group was significantly longer than that of RVAP group(P<0.05).2 years after operation,the pacemaker impedance of HBP group was significantly lower than that of RVAP group and pacemaker implantation at the same time(Pall<0.05),the duration of QRS was significantly shorter than that of RVAP group(P<0.05),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and 6 minute walking test(6 MWD)distance were significantly larger than those of RVAP group(Pall<0.05).There were significant differences in QRS duration,LVEF and 6 MWD distance preoperative compared with 2 years after operation in HBP group(Pall<0.05).There were significant differences in QRS duration,LVEDD,and 6 MWD distance preoperative compared with 2 years after operation in RVAP group(Pall<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion HBP can ensure ventricular synchronous contraction and improve cardiac function in patients with heart failure implanted with pacemakers.