单左心室起搏通过频率适应性房室延迟改善慢性充血性心力衰竭患者血流动力学的效果研究  

Effects of Left Univentricular Pacing through Rate Adaptive Atrio-ventricular Delay on Improving Hemodynamics of Patients with Chronic Congestive Heart Failure

作　　者：赵璐露 蒲里津[1] 赵玲[1] 王钰[1] 华宝桐[1] 郭涛[1] ZHAO Lu-lu PU Li-jin ZHAO Ling WANG Yu HUA Bao-tong GUO Tao(Department of Cardiology, First Affiliated Hospital of Kunming Medical Uitiversity, Kunming 650032, Chin)

机构地区：[1]昆明医科大学第一附属医院心内科云南省心血管病研究所,云南省昆明市650032

出　　处：《中国全科医学》2017年第2期133-138,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81360044);云南省科技厅资助项目(2013FB133)--昆明医科大学联合专项基金

摘　　要：目的应用双腔起搏器单左心室起搏频率适应性房室延迟(RAAVD)功能跟踪生理性的房室延迟,探索单左心室起搏RAAVD功能实现双心室收缩再同步化治疗慢性充血性心力衰竭(CHF)患者血流动力学的效果。方法选取2013年3月—2016年3月昆明医科大学第一附属医院心内科收治的CHF患者68例,采用随机数字表法将患者分为单左心室起搏RAAVD组(采用单左心室起搏RAAVD模式)和标准双心室起搏组(采用标准双心室起搏模式),各34例。测定两组患者心脏再同步治疗(CRT)术前、术后超声心动图指标,包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左房室瓣反流面积(MRA)、主动脉瓣前向血流速度时间积分(AVVTI)、E-A峰间距(E/A Pd)、心室间机械延迟时间(IVMD)以及12节段达峰时间标准差(Ts-SD12)。结果所有患者在植入起搏器后无血气胸、囊袋感染等并发症发生。术后平均随访时间为(17.3±9.6)个月,单左心室起搏RAAVD组在随访过程中1例患者死亡,标准双心室起搏组在随访过程中3例患者死亡。单左心室起搏RAAVD组和标准双心室起搏组术后LVEF、LVEDD、E/A Pd、Ts-SD12比较,差异均无统计学意义(P>0.05);单左心室起搏RAAVD组术后MRA、IVMD低于标准双心室起搏组,AVVTI高于标准双心室起搏组(P<0.05)。单左心室起搏RAAVD组和标准双心室起搏组术后LVEF、AVVTI均高于术前,术后LVEDD、MRA、Ts-SD12均低于术前(P<0.05);单左心室起搏RAAVD组术后IVMD低于术前(P<0.05)。结论应用单左心室起搏RAAVD功能,实现了安全、可行的生理性起搏,使得双心室收缩再同步,改善CHF患者的血流动力学,效果不劣于标准双心室起搏。Objective To achieve left univentricular pacing by dual-chamber pacemaker,to track the physiological atrio-ventricular delay by rate adaptive atrio-ventricular delay（ RAAVD） and to explore the effect of left univentricular pacing using RAAVD in achieving double ventricular resynchronization therapy on hemodynamics of patients with chronic congestive heart failure（ CHF）.Methods Sixty-eight patients with CHF,who received treatment in Department of Cardiology of First Affiliated Hospital of Kunming Medical University from March 2013 to March 2016,were selected in the study.They were divided into left univentricular pacing RAAVD group（ adopting left univentricular pacing RAAVD mode） and standardized biventricular pacing group（ using standardized biventricular pacing mode） by random number table method.Each group had 34 cases.The echocardiographic indicators of preoperative and postoperative cardiac resynchronization therapy（ CRT） among patients in two groups were detected.The detected indicators included left ventricular ejection fraction（ LVEF）,left ventricular end-diastolic dimension（ LVEDD）,mitral regurgitation area（ MRA）,velocity-time integral of forward flow of aortic valve（ AVVTI）,E/A peak duration（ E/A Pd）,inter-ventricular mechanical delay（ IVMD） and standardized deviation of time intervals of the 12 left ventricular segments（ Ts-SD12）.Results All patients had no complications such as pneumothorax and capsular infection after pacemaker implantation.The average follow-up period was（ 17.3 ± 9.6） months.One patient died during the follow-up of left univentricular pacing RAAVD group.Three patients died during the follow-up of the standardized biventricular pacing group.There was no significant difference in LVEF,LVEDD,E / A Pd and Ts-SD12 between the two groups（ P〈0.05）; the postoperative MRA and IVMD of left univentricular pacing RAAVD group were lower than those of standardized biventricular pacing group,while AVVTI was higher than that of standardized

关 键 词：心力衰竭 心脏再同步疗法 血流动力学 频率适应性房室延迟 单左心室起搏 

分 类 号：R541.6[医药卫生—心血管疾病]