慢性重度心力衰竭伴窄QRS波患者去肾交感神经术1年疗效  

Renal sympathetic denervation for patients with chronic severe heart failure and concomitant narrow QRS complex: observation of one-year curative effect

作　　者：杨伟[1] 刘宗军[1] 郜俊清[1] 金惠根[1] 徐佑龙[1] 徐三彬[1] 刘伟伟 YANG Wei;LIU Zongjun;GAO Junqing;JIN Huigen;XU Youlong;XU Sanbin;LIU Weiwei(Department of Cardiology, Affiliated Putuo Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai Municipal Putuo District Central Hospital, Shanghai 200062, Chin)

机构地区：[1]上海中医药大学附属普陀医院(上海市普陀区中心医院)心内科,200062

出　　处：《介入放射学杂志》2018年第6期500-503,共4页Journal of Interventional Radiology

基　　金：上海市卫生计生委面上项目(201440492);上海市卫生计生委重点项目(20134003);上海市卫生计生委医学重点专科建设项目(ZK2015A17)

摘　　要：目的 探讨去肾交感神经术(RDN)对慢性重度心力衰竭(心衰)伴窄QRS波并植入埋藏式心脏复律除颤器(ICD)患者心功能和恶性心律失常的改善作用。方法 20例心电图QRS波<0.12 s、左心室射血分数(LVEF)<40%的慢性心衰患者,随机分为ICD植入后行RDN术组(甲组,10例)、ICD植入后未行RDN术组(乙组,10例)。记录随访期各例美国纽约心脏病协会(NYHA)心功能分级、血生化测定、超声心动图指标、6 min步行试验(6MWT)及ICD放电次数。结果 平均随访1.86年。随访期甲组较乙组NYHA心功能分级显著降低(1.50±0.53比3.20±0.79,P<0.001),6MWT步行距离显著增大[(450.50±25.57)m比(120.60±13.24)m,P<0.001],血清脑钠肽(BNP)水平降低[(167.36±128.49)pg/m L比(2 232.29±2 451.64)pg/mL,P=0.016],左心室收缩末期内径缩小[(46.90±11.06)mm比(56.10±6.33)mm,P=0.035],LVEF增高[(39.50±9.63)%比(31.20±4.52)%,P=0.024]。随访末期甲组总ICD放电次数显著低于乙组(2次比40次,P<0.01);甲组RDN术后总放电次数显著低于术前(2次比31次,P<0.01)。结论 RDN术能有效改善慢性重度心衰伴窄QRS波患者长期心功能,提高运动耐量,减少ICD放电。Objective To investigate the effect of renal sympathetic denervation （RDN） on the improvement of cardiac function and malignant arrhythmia in chronic severe heart fai[ure patients with narrow QRS complex who receive implantable eardioverter defibrillator （ICD） therapy. Methods A total of 20 chronic heart failure patients with left ventrieular ejection fraclion（INEF） 〈40% and narrow QRS complex （〈0.12 s） were randomly divided into group A （n=10） and group B （n=10）. Patients in group A were h＇eated with ICD followed by RDN, while patients in group B received ICD only. During the fnllow-up period, the cardiae function grading （New York Heart Assncialion, NYHA）, blood biochemistry assessment, left ventrieular function judged by eehneardiography, 6-minute walking test （6MWT）, and number of ICD discharge of each patient were recorded. Results The patients were followed up for a mean period of 1.86 years. Compared with group B, in group A the NYHA function grading was significantly lower （ 1.50±0.53 vs 3.20±0.79, P〈 0.001 ）, the 6MWT distance was longer [（450.50±25.57） mvs （120.60±13.24） m, P〈0.0011, the serum level nf BNP was lower [（167.36±128.49） pg/mL vs （2232.29±2451.64） pg/mL, P=0.016], the left ventricnlar end- systolic diameter was smaller [ （46.90±11.06 ） mm vs （56.10±6.33 ） ram, P=0.035], and INEF was higher [（39.50±9.63）% vs （31.20±4.52）%, P=0.024]. In late follow-up period, the number of ICD discharge in group A was remarkably lower than that in group B （2 vs 40, P〈0.01 ）. In group A, the post-RDN number of ICD discharge was strikingly lower than pre-RDN one （2 vs 31, P〈0.01 ）. Conclusion RDN can effectively improve the longterm cardiac function for patients with chronic severe heart failure and narrow QRS complex, enhance exercise tolerance and reduce ICD discharge.

关 键 词：肾去神经化 心力衰竭 窄QRS波群 恶性心律失常 心功能 

分 类 号：R528[医药卫生—内科学]