心脏再同步化治疗优化策略研究  

Study on optimal strategy of cardiac resynchronization therapy

作　　者：李佳霖 李常青 许国卿 焉晓蕾 刘荣 徐白鸽 高阳 于海波 张权宇 梁延春 LI Jia-lin;LI Chang-qing;XU Guo-qing;YAN Xiao-lei;LIU Rong;XU Bai-ge;GAO Yang;YU Hai-bo;ZHANG Quan-yu;LIANG Yan-chun(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Graduate School,Dalian Medical University,Dalian 116044,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016 [2]大连医科大学研究生院,辽宁大连116044

出　　处：《临床军医杂志》2023年第12期1211-1215,共5页Clinical Journal of Medical Officers

基　　金：国家自然科学基金资助项目(32071116)。

摘　　要：目的比较心脏再同步化治疗(CRT)与传统双心室起搏(BVP)的临床治疗效果。方法选取北部战区总医院心血管内科接受CRT的135例患者为研究对象。将自2016年1月至2017年1月收治的接受传统BVP的56例患者纳入传统BVP组;将自2020年10月至2023年3月收治的应用CRT优化策略的79例患者纳入优化策略组。CRT优化策略为以起搏QRS波时限<130 ms为目标,依次尝试希氏束起搏(HBP)、左束支起搏(LBBP)、传统BVP及双侧间隔起搏联合冠状静脉起搏(BSP-CRT)。记录优化策略组患者方法学应用结果,比较两组患者改善心脏电学不同步效果和临床治疗效果。结果优化策略组79例患者中,56例(70.9%)采用了成功的传导束起搏进行CRT(11例为HBP,45例为LBBP),6例(7.6%)在HBP和LBBP失败后采用传统BVP纠正心脏电学不同步效果满意(QRS波时限<130 ms),17例(21.5%)因传统BVP的QRS波时限≥130 ms而尝试采用BSP-CRT。两组患者术后QRS波时限均较术前缩窄(P<0.05);优化策略组患者术后QRS波时限小于传统BVP组(P<0.05),QRS缩窄程度大于传统BVP组(P<0.05)。优化策略组患者术后QRS波时限<130 ms比例高于传统BVP组(P<0.05)。两组患者术后6个月左心室射血分数(LVEF)均较术前改善(P<0.05);优化策略组患者术后6个月LVEF高于传统BVP组(P<0.05),LVEF改善程度大于传统BVP组(P<0.05)。优化策略组对CRT的反应率和超反应率均高于传统BVP组(P<0.05)。结论以起搏QRS波时限<130 ms为目标,依次尝试HBP、LBBP、传统BVP及BSP-CRT的CRT优化策略在临床治疗效果上优于传统BVP。Objective To compare the clinical effects of cardiac resynchronization therapy(CRT)and traditional biventricular pacing(BVP).Methods A total of 135 patients who received CRT in the Department of Cardiology of General Hospital of Northern Theater Command were selected as the study objects.Fifty-six patients who received traditional BVP from January 2016 to January 2017 were included in the traditional BVP group.Seventy-nine patients treated with CRT optimization strategy from October 2020 to March 2023 were included in the optimization strategy group.The optimization strategy of CRT was to try His bundle pacing(HBP),left bundle branch pacing(LBBP),traditional BVP and bilateral septal pacing in combination with coronary venous pacing(BSP-CRT)with QRS duration<130 ms as the target.The results of patient methodology application in the optimization strategy group were recorded,and the effect of improving cardiac electrical dissynchronization and clinical treatment were compared between the two groups.Results Of the 79 patients in the optimization strategy group,56(70.9%)were successfully treated with conduction beam pacing for CRT(11 HBP,45 LBBP),and 6(7.6%)were satisfactorily corrected with traditional BVP after HBP and LBBP failures(QRS duration<130 ms).17 cases(21.5%)tried to adopt BSP-CRT because the QRS duration of traditional BVP was≥130 ms.The duration of QRS wave after operation was narrower than that before operation in the two groups(P<0.05).The duration of postoperative QRS wave in the optimization strategy group was smaller than that in the traditional BVP group(P<0.05),and the degree of QRS contraction was larger than that in the traditional BVP group(P<0.05).The proportion of QRS duration<130 ms in the optimization strategy group was higher than that in the traditional BVP group(P<0.05).Left ventricular ejection fraction(LVEF)was significantly improved 6 months after operation in both groups(P<0.05).LVEF in the optimization strategy group was higher than that in the traditional BVP group at 6 months af

关 键 词：心脏再同步化治疗 双心室起搏 室间隔 双侧间隔起搏 QRS波时限 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]