心脏再同步治疗对慢性心衰患者心功能、心律失常、运动能力及生活质量的影响

Influence of cardiac resynchronization therapy on cardiac function,arrhythmia,exercise performance and quality of life in patients with chronic heart disease

目的:观察心脏再同步治疗对慢性心力衰竭(CHF)患者心功能、心律失常、运动能力及生活质量的影响。方法:选择本院行心脏再同步治疗的95例CHF患者临床资料,观察治疗前、治疗12周后心功能、心律失常指标、运动能力变化,并采用明尼苏达心力衰竭生活质量调查问卷(MLHFQ)评估患者治疗前后的生活质量。结果:与术前比较,术后12周患者左室收缩末期容积(LVESV)[(138.90±25.28)ml比(119.87±20.78)ml]、二尖瓣返流面积(MRA)[(5.36±0.95)cm^2比(2.66±0.77)cm^2]、MRA/左房面积(LAA)[(30.87±8.48)比(20.03±5.61)]、各左室壁12节段的收缩达峰时间(TS)间的极差(Ts-maxD)[(112.44±15.1)ms比(62.82±13.23)ms]、各TS间的标准差(Ts-SD)[(22.48±5.41)ms比(14.77±2.86)ms]均显著减小(P均=0.001),左室射血分数(LVEF)[(29.44±4.12)%比(36.52±4.58)%]、左室内压最大变化速率(LVdp/dt)[(602.9±108.74)mmHg比(1325.19±188.85)mmHg]均显著提高(P均=0.001),房早、阵发房速、阵发房颤、阵发室速发生数均显著减少(P均=0.001),6min步行距离[(280.31±11.12)m比(387.46±17.01)m]显著增加(P=0.001),MLHFQ各项评分及总分[(67.59±8.29)分比(47.02±7.42)分]显著降低,生活质量显著改善(P均=0.001)。结论:心脏再同步治疗能够显著改善慢性心衰患者的左室收缩功能,减少房性心律失常、阵发室速的发生风险,提高患者活动能力与生活质量。

Objective:To observe influence of cardiac resynchronization therapy(CRT)on cardiac function,arrhythmia,exercise performance and quality of life(QOL)in patients with chronic heart failure(CHF).Methods:Clinical data of 95 CHF patients undergoing CRT in our hospital were selected.Changes of cardiac function,arrhythmia indexes and exercise performance before and 12 weeks after treatment were observed,and Minnesota living with heart failure questionnaire(MLHFQ)was used to assess QOL of patients before and after treatment.Results:Compared with before CRT,there were significant reductions in left ventricular end-systolic volume(LVESV)[(138.90±25.28)ml vs.(119.87±20.78)ml],mitral regurgitation area(MRA)[(5.36±0.95)cm^2 vs.(2.66±0.77)cm^2],MRA/left atrial area(LAA)[(30.87±8.48)vs.(20.03±5.61)],maximum difference among peak time to contraction(TS)of 12 segments of left ventricular wall(Ts-maxD)[(112.44±15.1)ms vs.(62.82±13.23)ms],standard deviation among each TS(Ts-SD)[(22.48±5.41)ms vs.(14.77±2.86)ms],numbers of atrial premature beat,paroxysmal atrial tachycardia,paroxysmal atrial fibrillation,paroxysmal ventricular tachycardia,each dimension score and total score of MLHFQ[(67.59±8.29)scores vs.(47.02±7.42)scores],and significant rise in LVEF[(29.44±4.12)%vs.(36.52±4.58)%],left ventricular inner pressure maximum rate of change(LVdp/dt)[(602.9±108.74)mmHg vs.(1325.19±188.85)mmHg]and 6 min walking distance[(280.31±11.12)m vs.(387.46±17.01)m],and significant improvement in QOL on 12 weeks after CRT,P=0.001 all.Conclusion:Cardiac resynchronization therapy can significantly improve left ventricular systolic function,reduce risk of atrial arrhythmia and paroxysmal ventricular tachycardia;d improve exercise performance and quality of life in CHF patients.