慢性心力衰竭患者心电图QRS波时限与心室电-机械不同步的关系  

Relationship between QRS duration of ECG and ventricular electrical-mechanical asynchrony in patients with chronic heart failure

作　　者：张琳[1] 焦锦玉 刘鸣 ZHANG Lin;JIAO Jinyu;LIU Ming(Wuhan University of Science and Technology Affiliated Wuhan Asia Heart Hospital;Medical School,Medical Department,Wuhan University of Science and Technology,Wuhan Hubei 430022;Department of Heart Function,Wuhan University of Science and Technology Affiliated Wuhan Asia Heart Hospital,Wuhan Hubei 430022,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院,武汉科技大学医学部医学院,湖北武汉430022 [2]武汉科技大学附属武汉亚洲心脏病医院心功能科,湖北武汉430022

出　　处：《实用心电学杂志》2024年第1期104-108,共5页Journal of Practical Electrocardiology

摘　　要：目前许多研究表明,QRS波时限与心室机械不同步并非完全呈线性关系,然而心室同步电激活是心室正常收缩舒张的重要先决条件。慢性心力衰竭(简称心衰)患者常常存在心室收缩功能障碍。尽管心衰初期心脏会发生适应性改变,但一旦超过代偿范围,就会导致心脏重构,使心功能严重受损。心电-机械重构受心脏结构、细胞水平和分子水平等因素的多重影响,在心电图上可以表现为QRS波时限增宽。在心衰的治疗方面,除了传统起搏器以外,近些年新兴的传导系统起搏更符合生理传导的特点,能在显著缩短QRS波时限的同时显著改善心室的机械同步性。本文综述了慢性心衰患者发生电-机械不同步的可能机制及其与QRS波时限的关系,以及二者对心功能的影响。At present,many studies have shown that QRS complex duration is not completely linear with ventricular mechanical asynchrony,however,synchronous ventricular electrical activation is an important prerequisite for normal systole and diastolic functions of the ventricle.Patients with chronic heart failure(HF)often have ventricular systolic dysfunction.Although in the early stages of HF,the heart makes adaptive changes,once the compensatory limit is exceeded,it can lead to heart remodeling and serious damage to heart functions.Electrocardiography and mechanical remodeling is influenced by multiple factors such as cardiac structure,and cellular and molecular levels,which is manifested by prolonged QRS complex duration in the ECG.In the treatment of HF,in addition to traditional pacemakers,the emerged conduction system pacing in recent years is more suitable to the characteristics of physiological conduction,not only significantly shortening the QRS complex duration but also significantly improving ventricular mechanical synchronization.This review summarizes the possible mechanisms of electrical-mechanical asynchrony in patients with chronic HF,and its relationship with QRS complex duration.It also covers the influence of the two factors on cardiac function.

关 键 词：心力衰竭 QRS波时限 电不同步 机械不同步 

分 类 号：R541.61[医药卫生—心血管疾病]