胸腔镜辅助心外膜电极植入同步化治疗慢性心功能不全  

The cardiac resynchronization therapy(CRT) for the chronic heart failure with video-assisted thorascope(VATS) epicardial electrode implantation

作　　者：陆世春 史宏灿 束余声 孙超 顾翔 

机构地区：[1]扬州大学临床医学院胸外科,江苏扬州225001 [2]扬州大学临床医学院心脏内科,江苏扬州225001

出　　处：《实用临床医药杂志》2012年第3期26-28,共3页Journal of Clinical Medicine in Practice

摘　　要：目的探讨胸腔镜辅助心外膜电极植入同步化(CRT)治疗慢性心功能不全的效果。方法 3例心肌病慢性心功能衰竭患者经心电图和超声心动图明确诊断心衰伴心脏不同步运动,DSA下植入左室起搏电极失败后采用胸腔镜辅助小切口植入左室心外膜起搏电极完成CRT。术后观察血流动力学、并发症、起搏参数、监护室和住院时间、心功能状况、心电图QRS波群时限的变化、超声心动图心脏同步运动状况。结果所有患者手术过程顺利,左室电极固定可靠,起搏阈值≤1 V。CRT治疗后心电图QRS波群时限<120 ms,超声心动图示心脏同步运动较术前明显好转。均于手术当日下午拔除气管插管,血流动力学指标平稳,于术后第2日转回普通病房。病例1和2术后1周出院,术后3月心功能恢复至Ⅱ级;病例3术后第3日出现急性肾功能衰竭,予持续肾脏替代治疗无效,术后第7天并发多脏器功能衰竭死亡。结论胸腔镜辅助植入心外膜电极CRT可用于慢性心衰的治疗,可作为介入方法失败后的选择,远期疗效还有待进一步的观察。Objective To explore the clinical value of CRT for the chronic heart failure with VATS epicardial electrode implantation.Methods Three cardiomyopathy heart failure patients confirmed with cardiac dysynchronization through ECG and UCG were included in the study.When the left ventricle endocardial electrodes implantation guided by DSA failed,the VATS technique was used to implant the left ventricle epicardial electrode and to accomplish CRT.The hemodynamics,complications,pacing parameters,length of stay,heart function,the latitude of ECG QRS wave group,and resynchronization features were observed after surgery.Results The epicardial electrodes were implanted successfully,which were firmly fixed on left ventricle post-lateral wall with pacing threshold ≤1v and the latitude of ECG QRS waves 〈120 ms.The cardiac synchronism movement after operation was much better than before,which were confirmed by UCG.All patients were extubated post meridiem in ICU when hemodynamics were stable,and returned to general ward on the second day.The first and second patients were discharged 1 week after operation,whose heart functions were back to NYHA Ⅱ 3 months after operation.Acute renal failure occurred in the third patient 3 days after implantation.CRRT was applied to rescue the patient,but failed.The patient died from MOSF 7 days after operation.Conclusion VATS epicardial electrode implantation can lead to good CRT results for cardiomyopathy heart failure patients,which can be used when DSA approach fails.The long-term effect should be further examined.

关 键 词：心脏再同步治疗 胸腔镜 心外膜电极 心力衰竭 

分 类 号：R454.1[医药卫生—治疗学] R445[医药卫生—临床医学]