超声指导下心脏再同步化治疗慢性心力衰竭的临床研究  

Echo-guided cardiac resynchronization in treatment of chronic heart failure patients

作　　者：张悦[1] 管小娟[1] 凌锋[1] 杨继东[1] 厉朝喜[1] 

机构地区：[1]浙江医院心内科,杭州310013

出　　处：《浙江医学》2013年第3期178-180,185,共4页Zhejiang Medical Journal

摘　　要：目的观察超声指导下心脏再同步化治疗（CRT）对慢性心力衰竭（CHF）患者的临床疗效。方法选择2008年9月至2012年1月接受CRT的CHF患者35例，于术后1周、3个月、9个月对房室（AV）和室室（VV）间期进行优化，观察术前及术后3、9个月的心功能分级、6min步行距离、QRS时间、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）及QRS波群起点距左心室12节段收缩速度峰值的时间标准差（Ts-12SD）、主动脉射血前期时间和肺动脉射血前期时间之差（IVMD）等指标的变化。结果与术前比较，35例患者平均术后心功能分级提高，6min步行距离增加，超声指标如LVEF、LVEDd及Ts-12SD、IVMD等指标明显改善（P〈0．01），随访时间延长，获益更显著（P〈0．01）。结论在超声指导下对AV、VV间期进行优化后行CRT可改善双心室的同步性和心脏功能。Objective To evaluate the echo-guided cardiac resynchronization therapy （CRT） for chronic heart failure （CHF） patients. Methods Thirty five CHF patients received CRT, the AV and VV intervals were optimized by echocardiography at 1 week, 3 and 9 months after pacemaker implantation. The echocardiography,heart function classification, distance of 6 rain walk test, QRS interval of all patients were evaluated during follow-up. Results The levels of NYHA functional class, 6- rain walk dis- tance of 35 patients were improved during follow-up; the left ventricular ejection fraction （LVEF）, left ventricular end-diastolic di- mension （LVEDd）, the standard deviation of regional time intervals in 12 left ventricular （Ts-12SD） and interventricular mechanical delay （IVMD） on echocardiography were significantly improved （P〈0.01） after device implantation. The improvement of these parameters was more markedly in later than earlier time after implantation （P〈0.01）. Conclusion CRT can improve the biventric- ular mechanical synchrony and cardiac function with AV/VV delay optimization guided by echocardiography.

关 键 词：心脏再同步化治疗 慢性心力衰竭 超声心动图 心功能 

分 类 号：R541.62[医药卫生—心血管疾病]