双心室起搏治疗充血性心力衰竭的临床疗效

Clinical evaluation of the therapeutic efficacy of biventricular pacing in patients with congestive heart failure

目的 :观察双室起搏治疗充血性心力衰竭 (CHF)的血流动力学及临床效果。方法 :CHF伴室内传导阻滞患者11例均植入双室起搏器 ,左室电极导线经冠状静脉窦插入抵达侧或后侧静脉 ,以达到左室起搏夺获。手术前、后应用 Swan- Ganz漂浮导管及超声心动图检查 ,观察双室起搏的血流动力学及临床效果。结果 :所有病例植入双心室起搏后临床症状改善 ,活动耐量增加。心输出量、心脏指数、射血分数均较术前明显改善。肺毛细血管嵌顿压下降 ,二尖瓣返流面积减少 ,治疗 3月后左心室舒张末期直径由 75± 8m m下降至 6 8± 6 m m(P<0 .0 5 )。结论 :双心室起搏治疗 CHF伴心室内传导阻滞患者 ,可明显缓解临床症状 ,逆转左心室重塑 ,改善心功能。

AIM: To evaluate the clinical and hymodynomic efficacy of biventricular pacing in the treatment of patients with chronic congestive heart failure. METHODS:11 patients with congestive heart failure and intraventricular conduction delay, ejection fraction <35% were recruited for biventricular pacing therapy. The hemodynamic parameters with biventricular pacing were evaluated by the echocardiography and Swan-Gans catheterization before and after the operation. RESULTS: After the biventricular pacing, the clinical symptoms were improved and cardiac output, cardiac index and LV ejection fraction increased. The wedged pressure of pulmonary capillaries went down;the size of mitral regurgitation was reduced and the left ventricular end-diastolic diameter decreased(75±8 vs 68±6 mm, P <0.05) after 3 months' pacing. CONCLUSION: The biventricular pacing reverses left ventricular remodeling and improves the clinical symptoms, cardiac function in patients with congestive heart failure and intraventricular conduction delay.