左心室起搏部位与心脏再同步化治疗疗效关系研究  

Relationship between left ventricular lead pacing position and the cardiac resynchronization therapy response in heart failure patients

作　　者：许国卿[1] 于海波[1] 刘荣[1] 高阳[1] 徐白鸽[1] 焉晓蕾 武敏 梁延春[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2017年第10期1007-1009,共3页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划面上项目(2015020406);辽宁省科学技术计划面上项目(2015020418)

摘　　要：目的分析左心室电极导线(LVL)起搏部位与心脏再同步化治疗(CRT)疗效的关系。方法回顾性分析沈阳军区总医院早期因扩张型心肌病(DCM)行CRT治疗的82例患者的临床资料。根据左心室电极起搏的部位将患者分为心尖部组(n=15)和非心尖部组(n=67)。采用超声心动图测量两组患者的左心室射血分数(LVEF)、左室舒张末内径(LVEDD)。比较两组患者治疗前后的LVEF、LVEDD、QRS时限及美国纽约心功能分级(NYHA分级)变化情况。结果术后6个月,非心尖部组LVEF及LVEDD较术前及心尖部组均明显改善(P<0.05);心尖部组术前及术后6个月的LVEF、LVEDD比较,差异均无统计学意义(P>0.05)。非心尖部组术后QRS时限较术前明显缩窄,NYHA分级改善明显(P<0.05),与心尖部组比较,差异也有统计学意义(P<0.05);而心尖部组术后QRS时限、NYHA分级与术前比较,虽有改善,但差异无统计学意义(P>0.05)。结论左室电极导线起搏非心尖部较心尖部CRT疗效更佳,应尽量避免左室心尖部起搏。Objective To investigate the relationship between the left ventricular lead（ LVL） pacing position and the effect of cardiac resynchronization therapy（ CRT）. Methods A retrospective study was performed on 82 cases of patients with dilated cardiomyopathy（ DCM） who were admitted and treated with CRT. According to the pacing location of LVL,patients were divided into the apical group（ n = 15） and non apical group（ n = 67）. Echocardiography was used to measure left ventricular ejection fraction（ LVEF） and left ventricular diastolic diameter（ LVEDD） in both groups. The changes of LVEF,LVEDD,QRS time and New York Heart Association（ NYHA） classification were compared between the two groups. Results After 6 months,LVEF and LVEDD compared with those before the surgery improved significantly in the non apical group（ P〈0. 05）; LVEF and LVEDD compared with those before the surgery had no statistically significant difference in the apical group（ P〉0. 05）. The significant improvement was observed in QRS duration and NYHA classification in the non apical group after operation（ P〈0. 05）,compared with those in the apical group,the difference was statistically significant（ P〈0. 05）; QRS duration and NYHA classification improved with no statistically significant difference compared with those before the surgery（ P〉0. 05）. Conclusion Left ventricular pacing is more effective than the apical group in CRT patients,so the left ventricular apical pacing should be avoided as far as possible.

关 键 词：心脏再同步化治疗 左心室电极导线 心力衰竭 

分 类 号：R541.62[医药卫生—心血管疾病]