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作 者:李阳[1] 张琳[1] 李健[1] 侯志文[1] 于波[1]
机构地区:[1]中国医科大学附属第一医院心内科,辽宁沈阳110001
出 处:《中国实用内科杂志》2017年第4期334-338,共5页Chinese Journal of Practical Internal Medicine
基 金:辽宁省科技公关课题(201225084)
摘 要:目的回顾性分析真性左束支传导阻滞、非真性左束支传导阻滞的慢性心力衰竭患者接受心脏再同步化治疗(CRT)的预后情况。方法选取2005年12月至2015年12月于中国医科大学附属第一医院成功植入CRT-P/D的慢性心力衰竭患者47例。根据术前体表心电图表现分为真性左束支传导阻滞组(t-LBBB,25例),非真性左束支传导阻滞组(nt-LBBB,22例),分析比较各组患者预后情况。结果t-LBBB组左室射血分数较nt-LBBB组增加[△LVEF:t-LBBB对nt-LBBB(17.12±6.80)%对(11.29±9.91)%,P=0.039];t-LBBB组左室舒末内径及左室收缩末容积较nt-LBBB组显著改善[△LVEDD:t-LBBB对nt-LBBB:(-9.88±6.55)mm对(-5.77±6.57)mm,P=0.041;△LVESV:t-LBBB对nt-LBBB:(-54.56±37.14)mL对(-25.59±46.81)mL,P=0.025]。多变量回归分析示真性左束支传导阻滞是CRT术后有反应的独立预测因子。结论QRS波形符合真性左束支传导阻滞标准的患者更能从CRT治疗中获益。Objective To analyze retrospectively the clinical response and prognosis of cardiac resynchronization therapy (CRT) for patients with chronic heart failure (CHF) with true complete left bundle branch block or non-true complete left bundle branch block. Methods TolaUy 47 patients were collected with implantation of CRT-P/D in the First hospital of China Medical University from Dec. 2005 to Dec. 2015. The 47patients were divided into 2 groups: true-complete hft bundle branch block (t-LBBB) group, (n=25), non-true left bundle block (nt-LBBB) group, (n=22). The difference in clinical materials and outcomes was analyzed in 2 groups. Results The mean absolute increases in LVEF in t-LBBB group were more significant than those in nt-LBBB group [△LVEF: t-LBBB vs. nt-LBBB:(17.12±6.80)% vs.(11.29±9.91)% P=0.039]; the mean absolute reduction in LVEDD and LVESV in t-LBBB group was also more significant than that in nt-LBBB group[△LVEDD: t-LBBB vs nt-LBBB: (-9.88±6.55)mm vs (-5.77±6.57)mm, P=0.041], [LVESV: t-LBBB vs nt-LBBB (-54.56±37.14)mL vs (-25.59±46.81) mL, P=0.025]. Multivariate analysis showed that t-LBBB was independent predictors of response to CRT. The non-LBBB group showed the worst clinical response and prognosis. Conclusion The patients with the t-LBBB morphology are related to a better response to CRT.
关 键 词:心脏再同步化治疗 慢性心力衰竭 真性左束支传导阻滞
分 类 号:R541.7[医药卫生—心血管疾病]
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