心室再同步起搏治疗慢性心力衰竭的长期疗效分析  

Long-term therapeutic effects of ventricular resynchronous pacing therapy on congestive heart failure

作　　者：李淑敏[1] 郭涛[1] 韩明华[1] 赵玲[1] 刘中梅[1] 薛强[1] 

机构地区：[1]昆明医学院第一附属医院心内科,昆明650032

出　　处：《临床心血管病杂志》2008年第4期256-259,共4页Journal of Clinical Cardiology

摘　　要：目的:观察心室再同步(CRT)起搏治疗慢性心力衰竭(CHF)的长期疗效及病死率。方法:49例CHF患者中,男40例,女9例,年龄31～82(56.3±11.0)岁。均有严重器质性心脏病,心功能(NYHA分级)Ⅲ～Ⅳ级,其中扩张型心肌病36例,缺血性心肌病9例,高血压性心脏病4例。所有患者心电图为窦性心律,ORS波>130ms,左室舒张末期内径(LVEDD)>60mm,左室射血分数(LVEF)<35%伴二尖瓣反流。49例中置入CRT40例,置入CRT心脏复律除颤器(CRT-D)9例。观察患者起搏器置入前,置入后1、3、6、12、24、36、48、60个月的心功能各项参数、生活质量(QOL)评分以及术后并发症、病死率与心血管事件。随访12～87(25.5±15.6)个月。结果:①并发症:电极脱位4例,囊袋出血2例;②病死率及死因:死亡15例(30.6%),其中CHF恶化死亡7例,心性猝死6例,非心源性死亡2例,49例患者中12例(24.5%)21次发生室性心动过速(VT)/心室颤动(Vf),其中3例CRT-D患者发生12次VT/Vf均被CRT-D成功纠治,3例CRT患者各发生1次VT/Vf经体外除颤纠治,6例CRT患者各因发生1次VT/Vf死亡;③心功能变化及QOL评分:37例(75.5%)患者LVEF、6min步行距离、心功能NYHA分级等心功能评价指标术后持续改善,11例(22.4%)患者心功能评价指标术后改善后再次恶化,1例无明显变化;49例患者QOL评分均较术前提高,LVEDD术后12个月明显缩小。结论:CRT治疗CHF能明显改善患者心功能,提高生活质量、6min步行距离、LVEF,缩小LVEDD,逆转左室重构;长期治疗,疗效巩固并能降低CHF导致的病死率,CRT-D可同时防治CHF及猝死事件的发生。Objective：To study the long-term therapeutic effects and mortality of ventricular resynchronous pacing therapy in patients with congestive heart failure. Method：A total of 49 patients were included. 40 men and 9 women, aged 31-82 （mean age of [56.3± 11.0]） years, with severe heart diseases and a cardic function of New York Heart Association （NYHA） classⅢ or Ⅳ. The etiologies of heart failure were idiopathic dilated cardiomyopathy （n=36）, ischemic heart disease（n=9）, hypertensive heart disease（n=4）. In all patients, 12-lead Electrocardiogram （ECG） displays sinus ryhthm, QRS duration was〉 130 ms, left ventricular end-diaStolic dimension （LVEDd） was〉60 mm, left ventricular ejection fraction （LVEF）〈 0.35 with mitral regurgitation. 40 patients were implanted with CRT and 9 patients with CRT-D. Heart function parameters and quality of life （QOL） score were repeatedlly measured before and 1 momth,3 months.6 months. 1 year, 2 years,3 years,4 years, 5 years after pacemaker implantation. Complication, mortality and cardiac incidents were also observed. The follow-up period varied from 12 months to 87 months. Result：①Complication： 4 cases of electrode dislocation and 2 cases of sac bleeding were recorded. ② Mortality and death cause： 15 patients died during follow-up （30.6%）. 7 congestive heart failure, 6 sudden cardiac death and 2 non-cardiac death. There appeared 21 events of VT/Vf attacked in 12 patients（24.50/00）, in which 12 such events in 3 patients had been prevented by CRT-D successfully and 3 patients with CRT had been respectively saved by the external defibrillation, but the other 6 patients with CRT died of VT/Vf unfortunately. ③Heart function and QOL： The indexes of the heart function such as LVEF 6MWT NYHA class,were being improved after implantation in the 37 cases （75.5 % ）, Such indexes deteriorated again after been improved in 11 cases （22.4 % ）; Such indexes in only one case had no change; The grade of QOL increased obviously

关 键 词：心力衰竭 充血性 心脏起搏器 人工 心室再同步 预后 

分 类 号：R541.6[医药卫生—心血管疾病]