肺动脉压力影响心脏再同步治疗的疗效和预后  

The impact of systolic pulmonary artery pressure on efficacy and prognosis in patients with cardiac resynchronization therapy

作　　者：王广川[1,2] 陈康玉 严激 徐健 孙贤林 安春生 苏浩 孙琦 杨冬妹 胡杨 

机构地区：[1]安徽医科大学附属省立医院心血管内科(安徽省心血管病研究所心血管内科),合肥230001 [2]淮北市人民医院心血管内科,淮北235000

出　　处：《安徽医科大学学报》2014年第12期1796-1799,共4页Acta Universitatis Medicinalis Anhui

基　　金：2010年安徽省卫生厅医学科研重点项目(编号:2010A002)

摘　　要：目的心脏再同步治疗(CRT)是慢性心力衰竭的有效治疗手段,但其疗效受到多种因素的影响,该研究试图讨论肺动脉收缩压(SPAP)对CRT的影响。方法选取行CRT起搏器植入的156例患者进行研究。分别在术前、术后1个月和术后6个月通过超声检测患者的SPAP,根据SPAP的高低,将患者分为SPAP正常组、轻度肺动脉高压(PH)组、中度PH组和重度PH组。随访1年,观察患者心衰住院和全因死亡的终点事件。结果与正常组相比,随着SPAP的增高,且左房内径(LAD)逐步增加。不同SPAP水平的患者,其CRT疗效各异(P<0.05),中重度PH的患者,CRT疗效显著下降。进一步分析显示,对CRT有反应患者的SPAP在术后1个月即有下降的趋势,在术后6个月时显著下降,而无反应患者的SPAP在术后6个月显著升高。为期1年的随访显示,SPAP越高,预后越差。结论 SPAP显著影响患者对CRT的反应性,随着SPAP的增加,CRT的疗效和预后均变差。CRT在改善患者心功能的同时,间接降低了SPAP。Objective Cardiac resynchronization therapy（CRT） has emerged as an effective treatment of chronic heart failure,however many factors contribute to CRT non-response.This study would explore the impact of systolic pulmonary artery pressure （SAPA） in patients with CRT.Methods 156 patients who received CRT were enrolled in this study.SAPA was assessed by echocardiography before,one month and six months after CRT.Patients were divided into normal group,mild pulmonary hypertension group,moderate pulmonary hypertension group and severe pulmonary hypertension group,according to the level of SPAP.The main endpoint events （heart failure hospitalization and all-cause death） were recorded within one-year follow-up.Results Compared with normal SPAP patients,left atria diameter increased with the elevated of SPAP.The effect of CRT differentiated by SPAP （P ＜ 0.05）,decreased significantly in moderate or severe pulmonary hypertension group.Further analysis found that,SPAP had the trend of decrease at one month after CRT in response group,and significantly at six month after implantation,while SPAP increased significantly at six month in non-response group.With the elevation of SPAP,the prognosis worsed.Conclusion SPAP influences the effect of CRT significantly.With the elevation of SPAP,the effect of CRT and prognosis is worsed.CRT improves cardiac function,and reduces the SPAP indirectly meantime.

关 键 词：心脏再同步治疗 慢性心力衰竭 肺动脉压力 无反应 

分 类 号：R541.6[医药卫生—心血管疾病]