双室起搏治疗充血性心力衰竭28周疗效观察

The following up of 7 patients with congestive heart failure treated by biventricular pacemaker implantation

目的 对充血性心力衰竭 (CHF)患者实施双心室起搏 (BVP)治疗 ,观察BVP对心功能的改善效果。方法 7例经反复药物治疗效果不佳的CHF患者接受BVP手术 ,其中男性 6例 ,女性 1例 ,年龄 4 8- 6 5岁 ,平均 (5 1± 6 )岁 ,扩张性心肌病 5例 ,缺血性心肌病 2例 ,心功能NYHA分级 ,Ⅲ级 6例 ,Ⅱ级 1例 ,病史 >1年。结果 所有病人均成功植入起搏器 ,平均随访 2 8周。心功能术前 (2 .9± 0 .3)级 ,术后 2 8周 1.4± 0 .5级 (P <0 .0 1) ;ECG示QRS波术前 (14 9± 35 )ms,术后 (98± 2 8)ms(P <0 .0 5 )。左室舒张末内径术前 (6 7± 7)mm ,术后 2 8周 (6 6± 7)mm(P>0 .0 5 )。左室射血分数术前 (2 2± 5 ) % ,术后 2 8周 (31± 4 ) % (P <0 .0 1)。二尖瓣反流分级 ,术前 (2 .4± 0 .5 )级 ,术后 2 8周 (1.1± 0 .6 )级 (P <0 .0 1) ,其中 1例术后二尖瓣返流消失。Tei多普勒推导指数 ,术前 0 .86± 0 .15 ,术后 2 8周 0 .6 2± 0 .0 7(P <0 .0 1)。结论 双室再同步起搏治疗充血性心力衰竭可改善病人心功能。

Objective Biventricular pacemaker (BVP) implantation was known to be one of beneficial therapeutic approach in treatment of congestive heart failure (CHF).Methods Seven patients with CHF were treated by the BVP implantation.Results The QRS duration of 149±35 msec before BVP implantation was significantly shortened to 98±28 msec after BVP implantation.Left ventricular ejection fraction increased significantly from (22±5)% to (31±4)%. Tei Doppler index significantly decreased from 0.86±0.15 to 0.62±0.07. Other clinical parameters were also improved after BPV implantation.Those included a significant reduction of a severity of mitral reguigitation from 2.4±0.5 to 1.1±0.6 and a significant improvement of an averaged NYHA class from 2.9 to 1.4.Conclusion These data strongly indicate that BVP implantation is an effective method for the treatment of the patients with CHF refractory to medical therapy.