儿童右心室起搏致心力衰竭后升级心脏再同步治疗五例长期随访  

A long-term follow-up study of cardiac resynchronization therapy for children with right ventricle-paced heart failure

作　　者：刘甜[1] 梁东坡[1] 张智伟[1] 王树水[1] 李渝芬[1] 钟翠瑶 曾少颖[1] Liu Tian;Liang Dongpo;Zhang Zhiwei;Wang Shushui;Li Yufen;Zhong Cuiyao;Zeng Shaoying(Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510800, China)

机构地区：[1]广东省心血管病研究所,广东省华南结构性心脏病重点实验室,广东省人民医院广东省医学科学院儿科,广州510800

出　　处：《中华儿科杂志》2019年第4期281-285,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨右心室起搏导致心力衰竭的患儿升级为心脏再同步治疗(CRT)的疗效及长期随访结果。方法2009年7月至2015年1月在广东省心血管病研究所因右心室起搏导致心力衰竭的5例患儿,予升级为CRT,患儿首次置入心内膜永久起搏器年龄为(11.6±4.6)岁,回顾性分析升级前后美国心脏病协会(NYHA)心功能分级、QRS间期、左心室舒张内径(LVDd)、左心室射血分数(LVEF)、左心室壁的收缩达峰时间标准差(TS-SD)的变化,并进行长期随访。组间比较采用配对t检验。结果起搏器升级后,患儿NYHA心功能分级改善为Ⅰ~Ⅱ级,QRS间期缩短[(126±9)比(182±21)ms,t=-7.480,P=0.002],LVDd缩小[Z值(2.8±1.1)比(4.7±0.9),t=-2.880,P=0.045],LVEF升高[(43±10)%比(28±6)%,t=3.350,P=0.029],差异有统计学意义,CRT有反应。升级后TS-SD下降[(48±17)比(95±41)ms,t=-2.240,P=0.090],但差异无统计学意义,最长随访9年,随访过程中,1例患儿升级后2年因心室颤动死亡,2例分别在升级后7.2年、5.8年因起搏器电池耗竭行CRT更换。结论右心室起搏导致心力衰竭的患儿,应尽早考虑升级CRT,升级后患儿心功能明显改善。Objective To evaluate the long-term effects of cardiac resynchronization therapy (CRT) in children with right ventricle-paced heart failure. Methods Five children with chronically right ventricular-paced heart failure underwent operation of upgrading to CRT in Guangdong Cardiovascular Institute between July 2009 to January 2015. The first time the patients were implanted with endocardial permanent pacemaker was (11.6±4.6) years old. The New York Heart Association (NYHA) functional classification, QRS duration, left ventricular end diastolic diameter (LVDd), left ventricular ejection fraction (LVEF), standard deviation of peak systolic time of left ventricular wall (TS-SD) and follow-up data were retrospectively analyzed. Comparison between pre-and post-operation was performed using paired t test. Results CRT significantly improved the NYHA class to Ⅰ-Ⅱdegree, reduced the QRS duration ((126±9)vs.(182±21)ms, t=-7.480, P=0.002) and the Z-score of LVDd (2.8±1.1 vs. 4.7±0.9, t=-2.880, P=0.045), and increased the LVEF (43%±10% vs. 28%±6%, t=3.350, P=0.029). No significant difference was found regarding the TS-SD ((48±17)vs.(95±41)ms, t=-2.240, P=0.090) pre- and post-CRT. The longest follow-up period was 9 years. During follow-up, 1 case died of ventricular fibrillation 2 years after upgrading, and 2 cases underwent CRT replacement due to battery depletion 7.2 years and 5.8 years after upgrading, respectively. Conclusion CRT could be considered for children with chronically right ventricular-paced heart failure and improve heart function significantly.

关 键 词：儿童 心力衰竭 心脏再同步治疗 

分 类 号：R725.4[医药卫生—儿科]