适应性左室起搏在慢性心力衰竭心脏再同步治疗中的应用  

Effects of adaptive left ventricular pacing on CRT in patients with chronic heart failure

作　　者：闫希贵 蔡尚郎[1] 赵青[1] 

机构地区：[1]青岛大学附属医院心血管内科,山东青岛266000

出　　处：《中国临床研究》2018年第2期154-157,共4页Chinese Journal of Clinical Research

摘　　要：目的观察适应性左室起搏在慢性心力衰竭心脏再同步治疗(CRT)中的应用效果。方法选取2014年1月至2016年7月符合CRT适应证的慢性心力衰竭患者64例,依据治疗方式不同分组,A组9例,为适应性CRT治疗组;B组19例,为右室感知触发左室起搏实现CRT治疗组;C组36例,为频率适应性房室延迟治疗组。分别比较3组起搏器植入术前后主动脉前向血流速度时间积分(VTI)、室间隔与左室后壁收缩时间差(SPWMD)、左室射血前时间(TQ-AV)与右室射血前时间(TQ-PV)差值(TQ-AV-TQ-PV)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、二尖瓣反流面积(MRA)、B型利钠肽(BNP)、QRS波时限、6 min步行距离(6-MWT)。结果 3组植入术后3、6、9、12个月QRS波时限、VTI、SPWMD、TQ-AV-TQ-PV、LVEF、MRA、LVEDD、BNP、6-MWT均较术前改善,差异有统计学意义(P均<0.05)。结论对慢性心力衰竭CRT患者分别予以适应性CRT、右室感知触发左室起搏实现CRT、频率适应性房室延迟治疗,均可有效改善其心脏功能,缩短QRS波时限,增加6-MWT,效果显著。Objective To observe the effect of adaptive left ventricular pacing on the cardiac resynchronous therapy（ CRT） in patients with chronic heart failure. Methods A total of 64 patients with chronic heart failure conforming to CRT indications between January 2014 and July 2016 were selected. The patients were divided into three groups according to the treatment method： group A（ adaptive CRT group,n = 9）,group B（ left ventricular pacing triggered by right ventricular sensing to achieve CRT,n = 19） and group C（ frequency adaptive atrio-ventricular delay treatment,n = 36）. The velocitytime integral（ VTI） of aortic forward flow,septal to left ventricular posteriorwallmotion delay（ SPWMD）,left ventricular preejection time（ TQ-AV） and right ventricular pre-ejection time（ TQ-PV） difference（ TQ-AV-TQ-PV）,left ventricular enddiastolic diameter（ LVEDD）,left ventricular ejection fraction（ LVEF）,mitralregurgitationarea（ MRA）,B-type natriuretic peptide（ BNP）,QRS wave duration and the distance of 6 min walking test（ 6-MWT） before and after pacemaker implantation were compared in three groups. Results QRS duration,VTI,SPWMD,TQ-AV-TQ-PV,LVEF,MRA,LVEDD,BNP and the distance of 6-MWT at 3-,6-,9-and 12-month after pacemaker implantation in three groups improved significantly（ all P〈0. 05）. Conclusion The adaptive CRT,left ventricular pacing triggered by right ventricular sensing to achieve CRT and frequency adaptive atrio-ventricular delay treatment may improve effectively cardiac functions,shorten QRS wave duration,increase the distance of 6-MWT and have an obvious efficacy in the patients with chronic heart failure receiving CRT.

关 键 词：慢性心力衰竭 心脏再同步治疗 适应性左室起搏 右室感知触发左室起搏 频率适应性房室延迟治疗 左室射血分数 房室延迟 QRS波时限 

分 类 号：R541[医药卫生—心血管疾病]