左室四极导线介导的多位点起搏技术在窄QRS波慢性心力衰竭患者的临床应用  

Clinical application of left ventricular quadrupole-mediated multi-site pacing(MPP)technique in patients with narrow QRS wave chronic heart failure

作　　者：胡威 马凌 苏芳菊 蔡晓庆 王菲 张卫泽 Hu Wei;Ma Ling;Su Fangju;Cai Xiaoqing;Wang Fei;Zhang Weize(Department of Cardiology,The 940th Hospital of Joint Logistics Support Force of Chinese PLA,Lanzhou 730050,China;不详)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院心血管内科,兰州730050 [2]兰州大学第二临床医学院,兰州730030 [3]西安国际医学中心医院心脏病医院,西安710100

出　　处：《中国循证心血管医学杂志》2021年第4期472-476,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨左室四极导线介导的多位点起搏(MPP)技术能否使合并窄QRS波(NQRSd)慢性心力衰竭(CHF)的患者临床获益。方法回顾性分析2016年1月至2018年12月期间于中国人民解放军联勤保障部队第九四〇医院心内科接受左室四极导线植入的13例慢性心力衰竭患者,入选患者QRS波时限限定为110~130 ms间,采用自身前后对照,比较所有入选患者术前、术后1日、术后1月、术后3月、术后6月B型钠尿肽(BNP)、QRS波时限(QRSd)、左室射血分数(LVEF)、左室前径、左室后径、左右室协调性、左房左室协调性、心胸比、6分钟步行试验(6MWT)和明尼苏达生活质量评分(MLHFQ)有无差异。结果随访6个月时,患者血浆BNP水平下降(P<0.001),QRSd缩短(P<0.001),LVEF提高(P<0.001),心胸比缩小(P=0.002),左右室协调性(P<0.001)、左房左室协调性(P<0.001)增加,6分钟步行试验增加(P<0.001),明尼苏达生活质量评分下降(P<0.001)。但左室前径(P=0.070)、左室后径(P=0.068)较术前均无明显变化。结论在CHF标准化药物治疗前提下,左室四极导线介导的多位点起搏(MPP)技术可以改善窄QRS CHF患者的心功能,提高生活质量,缩短QRS波,为窄QRS波CHF患者提供器械治疗依据;但该项技术短期内不能逆转心室重构。Objective To investigate whether multi-site pacing mediated by left ventricular quadrupole leads can benefit clinically patients with chronic heart failure and narrow QRS waves.Methods A retrospective analysis was conducted of 13 patients with chronic heart failure who underwent left ventricular quadrupole wire implantation in the Department of Cardiology of the 940th Hospital of the Chinese People's Liberation Army from January 2016 to 2018.The QRS waves of the selected patients was limited to 110~130 ms.Self-control was used.In all enrolled patients,type B natriuretic peptide(BNP),QRS duration(QRSd),and left ventricular ejection fraction(LVEF),left ventricular anterior diameter,left ventricular posterior diameter,left and right ventricular coordination,left atrialleft ventricular coordination,cardiothoracic ratio,6-minute walk test(6MWT),and Minnesota Quality of Life Score(MLHFQ)were compared before surgery,1 day after surgery,1 month after surgery,3 months after surgery,and 6 months after surgery.Results At 6 months of follow-up,plasma BNP level decreased(P<0.001),QRSd shortened(P<0.001),left ventricular ejection fraction increased(P<0.001),cardiothoracic ratio decreased(P=0.002),left and right ventricular coordination increased(P<0.001),left atrial and left ventricular coordination increased(P<0.001),6-minute walk test increased(P<0.001),and Minnesota quality of life score decreased(P<0.001).However,the left ventricular anterior diameter(P=0.070)and left ventricular posterior diameter(P=0.068)did not change significantly compared with those before surgery.Conclusion Under the premise of standardized drug therapy for chronic heart failure,left ventricular quadrupole lead-mediated multisite pacing(MPP)technology can improve cardiac function,improve quality of life,shorten QRS wave in patients with narrow QRS chronic heart failure,and provide a basis for device therapy for patients with narrow QRS wave chronic heart failure.However,this technology can not reverse ventricular remodeling in a short time.

关 键 词：左室四极导线 多位点起搏 窄QRS波 慢性心力衰竭 器械治疗 

分 类 号：R541.61[医药卫生—心血管疾病]