心脏再同步治疗中重度心力衰竭的疗效及无应答原因分析  

Analysis of non-response causes and effect of cardiac resynchronization therapy in patients with advanced congestive heart failure

作　　者：赵永辉[1] 张嘉莹[1] 周晗[1] 张静[1] 王现青[1] 付海霞[1] 

机构地区：[1]河南省人民医院心内科,郑州453003

出　　处：《临床心血管病杂志》2011年第12期929-933,共5页Journal of Clinical Cardiology

摘　　要：目的:通过对置入三腔起搏器的中重度心力衰竭患者进行随访观察,分析心脏再同步治疗(CRT)的临床疗效及对CRT无应答的原因。方法:24例慢性充血性心力衰竭患者,心功能Ⅲ～Ⅳ级(NYHA分级),其中扩张型心肌病18例,缺血性心肌病2例,致密化不全心肌病2例,病态窦房结综合征已置入双腔起搏器1例,Ⅲ度房室传导阻滞已置入单腔起搏器1例。随访12个月,观察CRT后临床和超声心动图指标的变化以及并发症的发生情况。结果:23例患者成功置入三腔起搏器,CRT成功率95.8%。与术前比较,NYHA心功能分级平均减低1.4级(P<0.01),左室射血分数平均提高12%(P<0.01),左室收缩末期容积降低38%(P<0.01),左室同步指数(左室12节段达峰值收缩速度的标准差)明显改善(术前74.12ms,术后40.78ms,P<0.01)。术中、术后并发症包括:冠状静脉窦夹层1例,左心室电极脱位2例,膈肌刺激2例,猝死1例。CRT无应答4例中包括并发心房颤动、完全性右束支阻滞、窄QRS波以及后侧壁坏死瘢痕组织的扩张型心肌病患者各1例。结论:CRT能改善心力衰竭患者的心功能、纠正左室机械失同步,逆转左室重构,但CRT存在一定的风险且部分患者无应答,应掌握好适应证、规范操作、密切随访和程控。Objective：To investigate the non-response causes and effect of cardiac resynchronization therapy（CRT） in patients with advanced congestive heart failure by one year follow-up.Method：Twenty-four patients with advanced congestive heart failure underwent CRT with New York Heart association（NYHA） class Ⅲ and Ⅳ.There were 18 patients with dilated cardiomyopathy,2 patients with ischemic cardiomyopathy,one with sick sinus node syndrome with dual-chamber pacemaker implantation,and one with the third AVB with single-chamber pacemaker implantation.Before CRT and 12 months after CRT,the clinical and echocardiographic parameters and complication were analysed.Result：Twenty-three patients were successfully implanted the biventricular pacemaker.The success rate is 95.8%.Compared with before CRT,NYHA class of patients after 12 months＇s CRT decreased by 1.4 class（P0.01）,left ventricular ejection fraction increased by 12%（P0.01）,left ventricular end systolic volume decreased by 38%（P0.01）,left ventricular synchrony index improved significantly（74.12 ms before CRT vs 40.78 ms after CRT,P0.01）.The complications during and after implantation procedure included coronary sinus dissection in 1,left ventricular lead dislodgement in 2,phrenic nerve stimulation in 2,sudden cardiac death in 1.4 patient with non-response were complicated with atrial fibrillation,complete right bundle branch block,narraow QRS wave and diated cardiomyopathy with postero-lateral scar tissue.Conclusion：CRT could improve the cardiac function,correct the mechanical desynchronization and reverse left ventricular remodeling in patients with congestive heart failure,however,there were complications related to the implantation procedure and non-response possibilities.In order to improve the cost-effectiveness ratio of CRT,we must pay attention to the indication,standard procedure,follow-up,and program control.

关 键 词：心力衰竭 心脏再同步治疗 无应答 

分 类 号：R541.6[医药卫生—心血管疾病]