心脏再同步化治疗后自身QRS波时限变化临床研究  

Clinical study of changes in native QRS duration after cardiac resynchronization therapy

作　　者：刘荣[1] 梁延春[1] 于海波[1] 徐白鸽[1] 高阳[1] 焉晓蕾 许国卿[1] 王娜[1] 王祖禄[1] 韩雅玲[1] LIU Rong;LIANG Yan-chun;YU Hai-bo;XU Bai-ge;GAO Yang;YAN Xiao-lei;XU Guo-qing;WANG Na;WANG Zu-lu;HAN Ya-ling(Department of Cardiology,The General Hospital of Shenyang Military Command,Shenyang 110016,China)

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》2018年第10期1160-1162,共3页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金(20180550901)

摘　　要：目的探讨心脏再同步化治疗(CRT)术后自身QRS波时限(QRSD)变化与心脏解剖逆重构的关系。方法选取自2013年2月至2016年2月于沈阳军区总医院接受CRT的60例心力衰竭患者为研究对象。根据CRT术后6个月自身QRSD变化将患者分为Ⅰ组和Ⅱ组,比较两组患者纽约心脏病协会(NYHA)心功能分级、6 min步行距离(6-MWT)、左室收缩末容积(LVESV)、左室射血分数(LVEF)、起搏QRSD、恶性心律失常事件及CRT应答率等;根据CRT有无应答分为CRT应答组、CRT无应答组,比较两组自身QRSD缩短患者的比例。结果术后6个月,Ⅰ组起搏QRSD明显短于Ⅱ组,两组间比较,差异有统计学意义(P <0. 05);Ⅰ组LVESV缩小明显大于Ⅱ组,两组间比较,差异有统计学意义(P <0. 05)。Ⅰ组CRT应答率显著高于Ⅱ组,两组间比较,差异有统计学意义(P <0. 05)。47例CRT应答,13例CRT无应答,CRT应答率为78. 3%(47/60)。CRT应答组26例(55. 3%)患者自身QRSD缩短,CRT无应答组2例(15. 4%)自身QRSD缩短,两组间比较,差异有统计学意义(P <0. 05)。结论 CRT术后自身QRSD变窄与心脏解剖逆重构具有相关性,QRSD变窄的患者CRT应答率较高。Objective To investigate the relationship between the changes of native QRS duration(QRSD)and cardiac anatomical remodeling after cardiac resynchronization therapy(CRT).Methods A retrospective study was performed on 60 cases of patients with heart failure who were admitted from February 2013 to February 2016.Patients were divided into the GroupⅠand GroupⅡaccording to their native QRSD changes at 6 months after CRT.The NYHA cardiac function grading,6-minute walking distance(6-MWT),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),pace QRSD,malignant arrhythmia events and CRT response rates were compared after CRT in both groups.According to the CRT response,the patients were divided into CRT response group and CRT non-response group.The proportion of patients with native QRSD shortening between the two groups was compared.Results Six months after surgery,QRSD inⅠgroup was significantly shorter than that inⅡgroup,and the difference was statistically significant(P<0.05);LVESV inⅠgroup was significantly longer than that inⅡgroup(P<0.05).The CRT response rate inⅠgroup was higher than that inⅡgroup(P<0.05).There were 47 CRT responses,13 CRT no responses,and the CRT response rate was 78.3%(47/60).Native QRSD was shortened in 26 patients(55.3%)of the CRT response group and in 2 patients(15.4%)of the CRT non-response group,and the difference was statistically significant(P<0.05).Conclusion The QRSD narrowing after CRT is correlated with the reverse reconstruction of cardiac anatomy,and the CRT response rate is higher in patients with QRSD narrowing.

关 键 词：心脏再同步化治疗 QRS波时限 左室收缩末容积 

分 类 号：R541[医药卫生—心血管疾病]