CRT对扩张型和缺血性心肌病的左室机械重构疗效观察  

Effect of cardiac resynchronization therapy on left ventricular remodeling in ischemic and dilated cardiomyopathy

作　　者：李驰 胡昌兴[1] 李庆宽[1] 覃绍明[1] 刘伶[1] 徐广马[1] 伍广伟[1] 林英忠[1] Chi Li;Chang-xing Hu;Qing-kuan Li;Shao-ming Qin;Ling Liu;Guang-ma Xu;Guang-wei Wu;Ying-zhong Lin(Department of Cardiology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning,Guangxi 530021, China)

机构地区：[1]广西壮族自治区人民医院心内科,广西南宁530021

出　　处：《中国现代医学杂志》2018年第8期62-65,共4页China Journal of Modern Medicine

基　　金：广西壮族自治区卫计委重点课题(No:桂卫重2012110)

摘　　要：目的观察心脏再同步化起搏治疗(CRT)对扩张型和缺血性心肌病的左室机械重构疗效差别。方法入选21例慢性充血性心力衰竭患者,分为扩张型心肌病组(13例)和缺血型心肌病组(8例)。所有患者均符合CRT指南的I类适应证。分别观察CRT术后6、12个月左室射血分数、左房内径、左室收缩内径、左室舒张内径、左室收缩末期容积、左室舒张末期容积及二尖瓣反流面积的变化。结果 (1)扩张型心肌病组CRT术后6个月,左室射血分数较术前增加,左室舒张和收缩末内径,左室舒张和收缩末容积,二尖瓣反流面积较术前减少(P<0.05),术后12个月,左室射血分数较术前增加,左室舒张和收缩末内径,左室舒张和收缩末容积,左房内径较术前减小(P<0.05);(2)缺血性心肌病组术后12个月射血分数较术前增加(P<0.05);(3)扩张型心肌病组CRT术后6个月二尖瓣反流面积的变化量大于缺血性心肌病组(P<0.05),射血分数增加量大于缺血性心肌病(P<0.05),术后12个月扩张型心肌病组左室收缩末内径、左室舒张和收缩末容积的变化量大于缺血性心肌病组(P<0.05)。结论 CRT对扩张型心肌病患者的心室逆重构效果优于缺血性心肌病患者。Objective To investigate the effect of cardiac resynchronization therapy(CRT)on left ventricular remodeling in patients with ischemic cardiomyopathy or dilated cardiomyopathy.Methods Twenty-one patients with congestive heart failure who were all in accordance with CRT guidelines for class I indication were enrolled.There were13patients with dilated cardiomyopathy and8patients with ischemic cardiomyopathy.The left ventricular ejection fraction(LVEF),left atrium diameter(LAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)and the area of mitral regurgitation(MRA)were observed6and12months after CRT.Results In the dilated cardiomyopathy patients,LVEF was increased,and LVESD,LVEDD,LVEDV,LVESV and MRA were reduced6months after CRT(P<0.05);LVEF was increased while LVESD,LVEDD,LVEDV,LVESV and LAD were reduced12months after CRT(P<0.05).In the ischemic cardiomyopathy group,LVEF was increased12months after CRT(P<0.05).MRA and LVEF in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group6months after CRT(P<0.05);LVESD,LVEDV and LVESV in the dilated cardiomyopathy group were changed more remarkably than those of the ischemic cardiomyopathy group12months after CRT(P<0.05).Conclusions The effect of CRT on left ventricular remodeling in patients with dilatedardiomyopathy is much better than that in patients with ischemic cardiomyopathy.

关 键 词：心脏再同步化治疗 慢性心力衰竭 扩张型心肌病 缺血性心肌病 左室重构 

分 类 号：R541.61[医药卫生—心血管疾病]