用超声指导下优化心脏再同步化疗法治疗慢性心衰的效果探究

Effect of ultrasound-guided optimized cardiac resynchronization therapy in the treatment of chronic heart failure

目的:探讨对慢性心衰患者进行超声指导下优化心脏再同步化治疗(CRT)的临床效果。方法:选取2017年至2018年期间在南京医科大学附属无锡第二人民医院接受超声指导下优化CRT的45例慢性心衰患者作为研究对象。对这45例患者均进行超声指导下优化CRT。然后,比较这45例患者接受治疗前及治疗3天、1个月、3个月后的左室射血分数(LVEF)、左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)、左室舒张末内径(LVd)、主动脉瓣前向血流速度积分(VTI)、左室充盈时间占心动周期百分比(LVFT/RR)、二尖瓣返流(MR)、12节段达最小收缩容积时间标准差(12Tmsv-SD)、12节段达最小收缩容积时间最大差(12Tmsv-Dif)、标化后的QRS波起点至整体纵向应变达峰时间的标准差(Gls-SD)、标化后的QRS波起点至整体环向应变达峰时间的标准差(Gcs-SD)、心室间机械延迟时间(TVMD)及其中重度、中度二尖瓣返流患者的占比。结果:这45例患者治疗前及治疗3天后的LVEDV、LVd、VTI相比,P>0.05;与治疗前相比,这45例患者治疗3天后的LVEF、LVFT/RR均更高,其LVESV、12Tmsv-SD、12Tmsv-Dif、Gls-SD、Gcs-SD、TVMD及其中重度、中度二尖瓣返流患者的占比均更低,P<0.05;与治疗3天后相比,这45例患者治疗1个月后的LVEF、VTI、LVFT/RR均更高,其LVESV、LVEDV、LVd、12Tmsv-SD、12Tmsv-Dif、Gls-SD、Gcs-SD、TVMD及其中重度、中度二尖瓣返流患者的占比均更低,P<0.05;与治疗1个月后相比,这45例患者治疗3个月后的LVEF、VTI、LVFT/RR均更高,其LVESV、LVEDV、LVd、12Tmsv-SD、12Tmsv-Dif、Gls-SD、Gcs-SD、TVMD及其中重度、中度二尖瓣返流患者的占比均更低,P<0.05。结论:对慢性心衰患者进行超声指导下优化CRT的临床效果较好。

Objective:To investigate the clinical effect of ultrasound-guided optimized cardiac resynchronization therapy(CRT)in patients with chronic heart failure.Methods:From 2017 to 2018,45 patients with chronic heart failure who received ultrasound guidance to optimize CRT in Wuxi Second People’s Hospital affiliated to Nanjing Medical University were selected as study subjects.The CRT was optimized under ultrasonic guidance in all the 45 patients.And then,Compare the 45 patients before treatment and treatment for 3 days,1 month,3 months after the left ventricular ejection fraction(LVEF),left ventricular contraction at the end of the volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic diameter(LVd),aortic valve prior to blood flow velocity time integral(VTI),left ventricular filling percentage of cardiac cycle(LVFT/RR),mitral regurgitation(MR),the standard deviation of the minimum contraction volume time 12 segments(12 TMSV-SD),12 segmental reaches the minimum contraction volume time maximum difference(12 TMSV-Dif),standardized the QRS Standard deviation(GLSSD),standard deviation(Gcs-SD),interventricular mechanical delay(TVMD),and proportion of patients with moderate to severe mitral regurgitation.Results:compared with the LVEDV,LVd and VTI of the 45 patients before treatment and 3 days after treatment,P>0.05 was found.Compared with those before treatment,the LVEF and LVFT/RR of the 45 patients after 3 days of treatment were all higher,and the proportion of LVESV,12TMSV-SD,12TMSV-DIF,GLS-SD,GC-SD,TVMD and patients with moderate to severe mitral regurgitation were all lower(P<0.05).Compared with 3 days after treatment,the LVEF,VTI,LVFT/RR of the 45 patients after 1 month of treatment were all higher,and the proportion of LVESV,LVEDV,LVd,12TMSV-SD,12TMSV-DIF,GLS-SD,GC-SD,TVMD and patients with moderate to severe mitral regurgitation was all lower(P<0.05).Compared with 1 month after treatment,the LVEF,VTI,LVFT/RR of the 45 patients after 3 months of treatment were all higher,and the proportion of LVESV,LVEDV,LVd,12TMSV-SD,12TMSV-DIF,GLS-SD,GMS-SD,TVMD and patients with moderate to severe mitral regurgitation was all lower(P<0.05).Conclusion:The clinical effect of CRT optimization und er ultrasound guidance is better in patients with chronic heart failure.