老年慢性心力衰竭患者双腔起搏器治疗前fQRS波群与临床应答及预后价值的关系  

Relationship Between fQRS Complex and Clinical Response and Prognostic Value Before Double Chamber Pacemaker Pacemaker Implantation in Elderly Patients with Chronic Heart Failure

作　　者：杨淇惠 郭华 金峰 YANG Qihui;GUO Hua;JIN Feng(Department of Electrocardiography,the First Outpatient Department of Henan Province,Zhengzhou 450003,China)

机构地区：[1]河南省直属机关第一门诊部心电图室,河南郑州450003

出　　处：《河南医学研究》2024年第3期477-481,共5页Henan Medical Research

摘　　要：目的 探讨和分析老年慢性心力衰竭患者起搏器植入前碎裂QRS波群(fQRS)与临床应答及预后之间的关系。方法 选择河南省直属机关第一门诊部于2016年1月至2019年12月收治的136例慢性心力衰竭老年患者为研究对象,根据患者起搏器植入治疗前是否存在fQRS分为fQRS组(34例)和非fQRS组(102例),比较两组患者起搏器植入术后6个月的临床应答情况,比较两组患者术前和术后6个月纽约心脏协会(NYHA)心功能分级、6分钟步行试验(6MWT)、明尼苏达州心力衰竭生活质量量表(MLHFQ)评分、左心室射血分数(LVEF)以及左心室收缩末期容积(LVESV)变化值。两组患者均随访3 a,比较两组患者的全因死亡和心力衰竭再住院率,采用Cox回归分析影响患者治疗后发生全因死亡的独立影响因素。结果 两组患者性别、年龄、既往疾病史(冠心病、心房颤动以及左束支传导阻滞)、入院时NYHA心功能分级之间差异无统计学意义(P>0.05),但fQRS组患者LVEF水平低于非fQRS组,氨基末端脑钠肽前体(NT-proBNP)水平高于非fQRS组,差异均具有统计学意义(P<0.001)。对两组患者均随访6个月,fQRS组中仅有18例(52.94%)患者出现临床应答,非fQRS组中有93例(91.18%)患者出现临床应答,差异具有统计学意义(P<0.001)。术后6个月时,fQRS组患者6MWT、NYHA心功能分级、MLHFQ、LVESV以及LVEF变化值均低于非fQRS组,差异均具有统计学意义(P<0.001)。术后随访3 a, fQRS组患者发生全因死亡率和因心力衰竭再住院率高于非fQRS组,差异具有统计学意义(P<0.001)。Cox回归分析结果显示术前fQRS(HR=2.328,95%CI 1.303~4.159)、术前NT-proBNP水平(HR=2.683,95%CI 1.441~4.994)均是影响CHF患者术后发生全因死亡的独立危险因素。结论 老年慢性心力衰竭患者起搏器植入治疗前出现fQRS波群会降低起搏器植入的临床应答率,且属于影响慢性心力衰竭患者全因死亡的独立危险因素,临床上应重点关注�Objective To explore and analyze the relationship between fragmented QRS complex(fQRS)complex and clinical response and prognosis before implant of pacemaker in elderly patients with chronic heart failure.Methods A total of 136 elderly patients with chronic heart failure admitted to the First Outpatient Department of Henan Province from January 2016 to December 2019 were selected as the research objects.According to whether the patients had fQRS before implant of pacemaker,they were divided into fQRS group(34 cases)and non-fQRS group(102 cases).The clinical response of the two groups of patients at 6 months after pacemaker implantation was compared,and the New York Heart Association(NYHA)cardiac function classification and 6-minute walking test(6MWT),Minnesota heart failure quality of life scale(MLHFQ)scores,left ventricular ejection fraction(LVEF)and left ventricular end systolic volume(LVESV)change value were compared between the two groups before and 6 months after the operation.Both groups of patients were followed up for 3 years,and the rates of all-cause death and heart failure re-hospitalization were compared between the two groups.Cox regression was used to analyze the independent factors influencing the occurrence of all-cause deaths after treatment.Results There were no significant differences between the two groups of patients in gender,age,previous disease history(coronary heart disease,atrial fibrillation,and left bundle branch block),and NYHA cardiac function classification at admission(P>0.05),but the LVEF level of in the fQRS group was lower than that of the non-fQRS group,and the level of N-terminal pro-brain natriuretic peptide(NT-proBNP)was higher than that of the non-fQRS group(P<0.001).After 6 months of follow-up,only 18 patients(52.94%)in the fQRS group had clinical responses,and 93(91.18%)patients in the non-fQRS group had clinical responses(P<0.001).At 6 months after surgery,the 6MWT,NYHA cardiac function classification,MLHFQ,LVESV and LVEF changes in the fQRS group were lower than those i

关 键 词：慢性心力衰竭 老年 起搏器 碎裂QRS波群 临床应答 预后 影响因素 

分 类 号：R541.6[医药卫生—心血管疾病]