不同类型心脏复律除颤在心源性猝死高危患者中的疗效对比分析  

Comparative analysis the efficacy of different types of cardioverter defibrillator in patients with high risk of sudden cardiac death

作　　者：焦峰军 李欢 任旭爱 施大为 崔涛 

机构地区：[1]陕西省咸阳市第一人民医院心内科,712000

出　　处：《疑难病杂志》2015年第11期1104-1106,1114,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨植入型心脏复律除颤器(ICD)、心室再同步化治疗(CRT)和心室再同步心脏复律除颤器(CRT-D)在心源性猝死高危患者中的疗效。方法选取2006年1月—2014年2月心源性猝死高危患者92例,其中ICD植入患者42例(ICD组),CRT植入患者43例(CRT组),CRT-D植入患者7例(CRT-D组),观察各组患者手术情况、手术时间、X线曝光时间及术后心血管事件、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、6分钟步行距离(6MWT)、病死率等。结果 ICD组手术成功率为100%,CRT组成功率为93.0%,CRT-D组成功率100%,3组手术成功率比较差异无统计学意义(P>0.05)。ICD组手术时间和X线曝光时间分别为(2.02±0.89)h和(8.32±2.62)min,明显短于CRT组的(3.04±1.2)h、(43.10±6.73)min和CRT-D组的(3.71±1.21)h、(35.21±7.61)min,差异有统计学意义(P<0.05);CRT-D组和CRT组手术时间比较差异无统计学意义(P>0.05);CRT-D组X线曝光时间短于CRT组,差异有统计学意义(P<0.05)。ICD组手术前后LVEF、LVEDD无明显变化,6MWT有明显改善(P<0.05);CRT组患者术后1个月LVEF即有明显改善,术后6个月6MWT有明显改善,术后1年LVEDD改善有统计学意义(P<0.05);CRT-D组术后LVEF、6MWT有明显改善(P<0.05),而LVEDD手术前后无明显变化(P>0.05)。CRT-D组无患者死亡,ICD组病死率为11.9%(5/42),CRT组病死率为16.3%(7/43),3组病死率比较差异无统计学意义(P>0.05)。结论 ICD、CRT和CRT-D对心性猝死高危患者均有明显的保护作用,而患者应合理选择ICD、CRT和CRT-D 3种治疗方式,以获得最佳效价比。Objective To investigate the curative effect of implantable cardiac defibrillator（ICD）,cardioverter resynchronization therapy（CRT） and ventricular resynchronization therapy with defibrillators（CRT-D） in the cardiogenic sudden death high-risk patients.Methods Selected from 2006 January to 2014 December,92 cases of cardiogenic sudden death high-risk patients,42 cases of patients with the ICD implantation（ICD group）,43 cases of patients implanted with a CRT（CRT group）,7 cases of patients with CRT-D implantation（CRT-D group）,to observe different groups of patients＇ operation,operation time,X-ray exposure time and postoperative cardiovascular events,left ventricular ejection fraction（LVEK）,left ventricular diastolic end diastolic diameter（LVEDD）,6 minutes walk distance（6MWT） and fatality rate etc.Results ICD group operation success rate was 100%,in the CRT group success rate was 93.0%,CRT-D group success rate was 100%,3groups＇ surgery success rate＇s differences were not statistically significant（P〉0.05）.ICD group＇s operation time and fluoroscopy time were（2.02 ±0.89） h and（8.32 ±2.62） min respectively,significantly shorter than tin the CRT group（3.04 h ±1.2 h,43.10 min ±6.73 min） and CRT-D group（3.71 h±1.21 h,35.21 min ±761 min）,the difference were statistically significant（P〈0.05）;difference between the CRT-D and CRT group＇s operation time showed no statistical significance（P〉0.05）;CRT-D group＇s X-ray exposure time was shorter than the CRT group,the difference was statistically significant（P〈0.05）.ICD group before and after surgery,patients＇ LVEK,LVEDD had no obvious changes,6MWT have significantly improvement（P〈0.05）;patients in the CRT group 1 month LVEF was obviously improved,after 6 months,6MWT have significantly improved,postoperative 1 year＇s LVEDD improvement was statistically significant（P〈0.05）;CRT-D group＇s LVEF,6MWT have significantly improvement（P〈0.05）,and LVEDD before and after surgery s

关 键 词：植入型心脏复律除颤器 心室再同步化治疗 心室再同步心脏复律除颤器 心源性猝死高危患者 疗效 

分 类 号：R654.2[医药卫生—外科学]