优化起搏参数在提高心脏再同步化治疗疗效中的作用  

Study on significance of optimal pacemaker parameters in improving the efficacy of cardiac resynchronization therapy

作　　者：谢芳[1] 何亚峰[1] 邓成钢[1] 程光辉[1] 张劲林[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022

出　　处：《临床和实验医学杂志》2015年第3期189-191,共3页Journal of Clinical and Experimental Medicine

基　　金：武汉市2010-2011年度卫生行业基金资助项目(编号:WX11D14)

摘　　要：目的探讨优化A-V、V-V间期在提高心脏再同步化治疗（CRT）中的疗效。方法 49例CRT治疗的慢性心力衰竭患者,于术后1周、3个月、6个月和12个月进行个体化参数程控（在超声心动图指导下优化A-V间期,在组织多普勒显像下优化V-V间期）,观察心脏同步性和心功能变化,达到CRT最佳治疗目的。结果临床症状：45例CRT后心功能得到改善,心功能NYHA分级,从Ⅲ～Ⅳ级提高为Ⅱ～Ⅲ级,6分钟步行距离增加。超声指标：反映左室收缩功能的指标左室射血分数（P〈0.01）、血流速度积分（VTI）增加,反映左室舒张功能的指标左室舒张充盈时间延长,评价心腔大小指标改善,术后3、6个月左心室舒张末期内径、舒张末期容积小于术前（P〈0.01,P〈0.05）;二尖瓣反流量减少;12节段达峰时间标准差术后较术前缩短,差异有统计学意义（P〈0.01）。结论慢性心力衰竭患者个体化的参数优化可以提高CRT疗效。Objective To evaluate the efficacy of cardiac resynchronization therapy（ CRT） in treatment of patients with AV or VV delay.Methods Forty- nine patients with chronic heart failure received cardiac resynchronous pacing,followed- up for 1 week,3 months,6 months and 1 year,the delay of AV had been optimized by ultrasound cardiography,and delay of VV had been optimized by tissue Doppler imaging. Results Heart function in 45 cases had been improved after CRT. According to NYHA classification,these patients had been improved from class Ⅲ ～ Ⅳ to class Ⅱ ～ Ⅲ,and their 6 minutes walking distance had also been increased. The LVEF index and VTI of left ventricular systolic function had been improved（ P 0. 01）. Left ventricular diastolic filling time was also increased. In 3 months and 6 months after the treatment,left ventricular end diastolic diameter and volume were significantly smaller than those before the treatment（ P 0. 01,P 0. 05）. Mitral regurgitation had been reduced,and the standard deviation of 12 segments time to peak had been decreased from（ 139 ± 33） ms to（ 110 ± 40） ms（ P 0. 01）. Conclusion Optimization of the pacemaker parameters is needed in order to enhance the efficacy of CRT.

关 键 词：慢性心力衰竭 心脏再同步化治疗 起搏参数 

分 类 号：R541.6[医药卫生—心血管疾病]