心力衰竭患者心脏再同步治疗术后死亡原因的相关性分析  

Relativity analysis on cause of death in patients with heart failure after cardiac resynchronization therapy

作　　者：方毅[1] 陈家林[1] 

机构地区：[1]广东省深圳市第二人民医院心内科,广东深圳518035

出　　处：《中国医药导报》2013年第20期41-42,45,共3页China Medical Herald

摘　　要：目的探讨心力衰竭患者心脏再同步治疗(CRT)术后的死亡原因及相关影响因素。方法对深圳市第二人民医院心内科2008年1月～2012年6月52例行CRT的心力衰竭患者进行随访,根据患者心律及起搏器功能分为三组进行观察:持续性房颤CRT组8例,窦性心律CRT组40例和窦性心律心脏再同步治疗除颤器(CRT-D)组4例,观察患者术后的转归情况,以及死亡患者的死亡原因、生存时间和相关影响因素。结果 52例患者均完成随访,时间为4～57个月,平均(38±10)个月,总病死率为32.7%(17/52)。心脏性死亡14例,占82.4%,其中6例为心力衰竭恶化,8例为心脏性猝死(SCD);其余3例为非心脏性死亡。持续性房颤CRT组5例死亡;窦性心律CRT组12例死亡;窦性心律CRT-D组均无死亡;三组患者的病死率差异有统计学意义(P=0.01)。合并慢性肾功能衰竭的CRT患者病死率(62.5%)较无肾功能衰竭者(19.4%)高(相对危险度为4.302,95%CI为1.598～5.889,P<0.01)。结论心脏性死亡是CRT患者的主要死亡原因,其中包括心力衰竭恶化和SCD。CRT-D和CRT患者之间的病死率差异有统计学意义,窦性心律患者接受CRT较持续性房颤患者有显著的获益,另外合并慢性肾功能衰竭CRT患者的预后较差。Objective To explore the cause and the factors related to death in patients with heart failure （HF） after cardiac resynchronization therapy （CRT）. Methods 52 patients with congestive heart failure treated with CRT were enrolled in this study who were chosen from January 2008 to June 2012 at Second People＇s Hospital of Shenzhen City including 4 patients underwent CRT ＋ an implantable defibrillator （CRT-D）. The postoperative outcome, cause of death, survival time and the factors related to death were observed during the long follow-up. Results The mean follow-up period was 4-57 months, （38＋10） months on average, while 52 patients had completed the foUow-up. 17 patients died （32.7%）, 14 of them （82.4%） were cardiac causes （pump failure of 6 cases, sudden cardiac death of 8 cases）, and 3 patients due to non-cardiac causes. 5 patients with persistent atrial fibrillation （n = 8）died, 12 patients with sinus rhythm （n = 40） died, all patients with sinus rhythm who underwent CRT-D （n = 4） were survival. There were significant differences （P = 0.01） in the mortality among the three groups. The mortality in patients with chronic renal failure （CRF） was higher than those without CRF （HR： 4.302, 95%CI 1.598-5.889, P 〈 0.01）. Conclusion Cardiac death, including heart pump failure and sudden cardiac death are the predominant causes of death in patients after CRT. Patients with persistent atrial fibrillation or CRF have disadvantage in survival. CRT-D improve survival rate, and atrio-ventrieular node tibiation in patients with persistent atrial fibrillation may be a way to improve survival rate.

关 键 词：心力衰竭 心脏再同步治疗 死亡原因 相关性分析 

分 类 号：R541.61[医药卫生—心血管疾病]