右房左室起搏治疗慢性心力衰竭伴室内传导阻滞患者的初步临床观察  

Clinical Study of Right Atrial-Left Ventricular Pacing Therapy for Patients With Chronic Heart Failure

作　　者：徐亚伟[1] 于学靖[1] 丁燕生[2] 张丽崴[3] 盛铁仁[1] 陈艳清[1] 沈国才[1] 李伟明[1] 王永其[1] 胡全福[1] 

机构地区：[1]同济大学附属铁路医院心内科,上海200072 [2]北京大学第一医院心内科 [3]上海市第七人民医院

出　　处：《中国心脏起搏与心电生理杂志》2004年第3期175-177,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：观察右房 左室起搏治疗慢性心力衰竭 (简称心衰 )的临床效果。选择 1 6例充血性心衰患者 (NYHA分级Ⅲ Ⅳ级 ) ,男 1 0例、女 6例 ,年龄 6 8.4± 6岁 ;均为窦性心律 ,合并有Ⅰ度房室阻滞 ,完全性左束支阻滞。按安置起搏器的模式分为右房 左室起搏治疗组 (LV组 ,n =6 ) ,右房双室起搏治疗组 (BiV组 ,n =1 0 )。左室起搏电极分别放置于心大静脉左室侧后分支 9例 ,心大静脉左室后分支 7例。观察起搏治疗前后左室心功能参数、6min步行距离、左室壁运动的同步性及体表心电图的变化。结果 :BiV组左室射血分数 (LVEF)由术前的 0 .2 3提高至 0 .31 (P <0 .0 0 1 ) ;在LV组LVEF由术前的 0 .2 4提高至 0 .33(P <0 .0 0 1 ) ;左室舒张末期容积指数在二组分别由术前的 1 4 9± 5 1ml/m2 和 1 5 3±5 3ml/m2 下降至 1 1 6± 38ml/m2 和 1 2 1± 4 1ml/m2 (P均 <0 .0 0 1 ) ;室间隔与左室后壁运动的延迟时间在二组分别由术前的 1 95± 94ms和 1 97± 89ms下降至 1 7± 6 0ms及 1 6± 5 6ms(P均 <0 .0 0 1 )。 6min步行距离则分别由术前的4 0 3± 5 3m和 4 0 1± 5 9m提高至 4 4 1± 6 2m和 4 4 2± 6 7m(P均 <0 .0 5 )。结论 :初步临床观察提示右房 左室起搏治疗与右房双室起搏治疗相比 ,同样可有效地改善慢性心衰?To study the clinical effect of right atrial left ventricular pacing therapy in patients with chronic heart failure,16 patients ,10 male and 6 female,mean ages of 72 years,with refractory chronic heart failure and left bundle branch block were investigated. All of them were sinus rhythms. The mean QRS width was 140～190 ms; The mean of left ventricular ejection fraction(LVEF) was 0.23.10 of them received biventricular synchronous pacing(BiV group, n=10),6 of them received right atrial left ventricular pacing (LV group,n=6)and the coronary sinus lead was inserted into the branch of coronary sinus to pace left ventricular. Results:After biventricular synchronous pacing and right atrial left ventricular pacing, the heart function was significantly improved. In the BiV Group,the LVEF was increasd from 0.23 to 0.31( P<0.05). In the LV Group,the LVEF was increasd from 0.24 to 0.33( P<0.05);The left ventricular end diastolic volume index was decreased from 149±51 ml/m 2 and 153±53 ml/m 2to 116±38 ml/m 2及121±41 ml/m 2 respectively,(P<0.001).The the septal to posterior wall motion delay,a left intraventricular asynchrony parameter, was decreased from 195±94 ms(BiV group)and 197±89 ms(LV group) to 17±60 ms and 16±56 ms respectively(P<0.001).The 6 min walk distance increased from 403±53 m(BiV group) and 401±59 m(LV group) to 441±62 m and 442±67 m respectively(P<0.001).Conclusion:The right atrial left ventricular pacing therapy can improve hemodynamic effect in patients with chronic heart failure and left bundle branch block.

关 键 词：心血管病学 心力衰竭 充血性 左室起搏 起搏部位 

分 类 号：R541.61[医药卫生—心血管疾病] R318.11[医药卫生—内科学]