心脏再同步化治疗术后精准管理价值研究

Value of precision management after cardiac resynchronization therapy

目的 探讨心脏再同步化治疗(CRT)术后精准管理对改善患者症状及CRT反应率的影响。方法 收集2020年1月1日至2021年12月31日于苏北人民医院住院首次行CRT的心力衰竭(HF)患者97例,分为对照组53例和精准管理组44例。分析2组CRT反应率差异及发生因HF再入院或病死率的差异。结果 精准管理组术后12个月总有反应比例高于对照组(88.64%vs 69.81%,P<0.05)。Kaplan-Meier生存曲线分析显示,精准管理组无临床关注事件生存率高于对照组(P=0.018)。多因素Cox回归分析显示,术后未接受精准管理(HR=0.21,95%CI:0.09~0.47,P=0.005)、术前一年内因HF入院(HR=3.94,95%CI:1.70~9.14,P=0.005)是CRT术后发生临床关注事件的主要预测因素。结论 CRT术后精准管理可使患者CRT反应率增加,降低患者因HF再入院或死亡的风险,有效改善患者预后。

Objective To investigate the effect of precision management on improving the symp-toms and response rate of patients after cardiac resynchronization therapy(CRT).Methods A to-tal of 97patients with heart failure(HF)who received CRT for the first time in Department of Cardiology,Northern Jiangsu People's Hospital from January 1,2020to December 31,2021were enrolled in this study.They were divided into control group(53cases)and precision management group(44cases).CRT response rate and incidence of HF readmission or death were compared be-tween the two groups.Results The precision management group had significantly larger propor-tion of total response in 12 months after CRT than the control group(P<0.05).Kaplan-Meier survival analysis showed that the survival rate without clinical concern was obviously higher in the precision management group than the control group(P=0.018).Multivariate Cox regression analysis indicated that no precision management after surgery(HR=0.21,95%CI:0.09-0.47,P=0.005)and hospitalization for HF within 1year before surgery(HR=3.94,95%CI:1.70-9.14,P=0.005)were the main predictors of clinical events of concern after CRT.Conclusion Postoperative precision management of CRT can increase the CRT response rate,reduce the risk of readmission or death due to HF,and improve the prognosis effectively.