ICD、CRT、CRT-D对猝死高危人群的疗效比较  

The Comparison of Efficiency in Pretecting Patients with High-risk of Sudden Cardiac Death with ICD,CRT,or CRT-D

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

机构地区：[1]昆明医学院第一附属医院心内科,云南昆明650032

出　　处：《昆明医学院学报》2008年第2期93-99,103,共8页Journal of Kunming Medical College

摘　　要：目的对比植入型心脏复律除颤器(ICD)、心室再同步(CRT)和心室再同步心脏复律除颤器(CRT-D)在心性猝死高危患者中的疗效及实施技术的可行性与合理性.方法采用逐步纳入研究的方法连续收集109例心性猝死高危患者,分别植入ICD55例,CRT46例,CRT-D 9例.记录患者术前、术后临床相关资料及心功能评价指标等,所有资料进行自身对比与组间比较.结果ICD、CRT-D和CRT组手术成功率分别为100%、100%和86.9%.术后随访5～101(平均29±18)月,ICD组7例死亡(12.7%),CRT组14例死亡(35.0%),CRT-D组无死亡.植入ICD和CRT-D的63例患者中,37例共发生951次室性心动过速(VT)/心室颤动(VF)事件,除1次因电池耗竭失败外,均被ICD/CRT-D有效纠治.植入CRT/CRT-D的49例患者中,37例的左室射血分数(LVEF)、6 min步行距离(6MWT)、心功能分级和左室舒张末内径(LVEDD)等心功能评价指标较术前有不同程度改善且持续致随访结束(75.5%),11例心功能改善,但未持续至随访结束(22.4%).3组患者生活质量(QOL)评分均较术前提高.结论ICD、CRT、CRT-D均对猝死高危患者有明显的保护作用,ICD更适合于充血性心力衰竭(CHF)较轻但有VT/VF发作史或高发倾向的患者,CRT更适合于CHF较重的患者,CRT-D应作为严重心脏器质性疾病有猝死高危患者的首选治疗.Objective To compare the curative effcet for sudden cardiac death with ICD, CRT, or CRT-D and investigate the feasibility and rationality of implementing on technic. Methods 109 patients with high crisis of sudden cardiac death were collected gradually. 55 cases were implanted with ICD, 46 cases were implanted with CRT, 9 cases were implanted with CRT-D respectively. The clinic character and the grade of cardiac function in NYHA before operation and after operation were noted. All the data were compared in every group and between groups. Results Percentage of success was 100% in the operation of implanting ICD, 100% in CRT-D, 86.9% in CRT. They were followed up from 5 months to 101 months after operation. Average was （ 29 ± 18） months. In the period of following up, 7 patients died in the group of ICD （12.7%） , 14 patients died in the group of CRT （35.0%）. There was no death in the group of CRT-D. 951 events of VT / VF attacked in 37cases were prevented by ICD and CRT-D successfully （ratio is 99.9%） in 63 cases planted with ICD or CRT-D except for 1 failed of exhuausting in battery. The index for evalute cardiac function of LVEF,6MWT, the grade of cardiac function in NYHA and LVEDD et al in 37 cases improved in different degree contrast to the time before operation in 49 cases planted with CRT or CRT-D, forthermore, the improving hold to the end of follow-up （75.5%）. Cardiac function in the other 11 cases improved also, but not persist to the end of follow-up （22.4%）. Grade of QOL of 3 groups all improved more than the the one of the preoperative patient. Gonclusions Therapy for patients having high crisis of sudden cardiac death with ICD, CRT, CRT-D will acquire obvious protection. ICD is more fitted for patients who have no severe CHF, but have VT/VF attacked before or have high crisis of VT/VF. CRT is more fitted for patients with severe CHF. CRT-D must be preferred to the patients with severe heart disease

关 键 词：植入型心脏复律除颤器 心室再同步 心室再同步心脏复律除颤器 猝死 疗效 

分 类 号：R318.11[医药卫生—生物医学工程] R541.7[医药卫生—基础医学]