心室再同步起搏治疗慢性心力衰竭伴室内传导延迟患者的近期观察  

Clinical observation of resynchronization therapy for patients with chronic heart failure

作　　者：华伟[1] 王方正[1] 张澍[1] 张奎俊[1] 牛国栋[1] 马坚[1] 姚焰[1] 陈柯萍[1] 楚建民[1] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院临床电生理研究室,北京100037

出　　处：《中华心血管病杂志》2003年第1期21-23,共3页Chinese Journal of Cardiology

摘　　要：目的　观察双心室同步起搏治疗慢性心力衰竭 (心衰 )的临床效果。方法　慢性心衰伴心室内传导延迟患者 56例 ,男性 43例 ,女性 1 3例 ,平均年龄 52 9岁。心功能均在Ⅲ～Ⅳ级 (NYHA) ,体表心电图QRS波平均为 (1 4 3 1± 1 9 4)ms。其中 5例为慢性心房颤动 (房颤 ) ,其余为窦性心律患者 ,患者均进行了双心室同步起搏。慢性房颤患者先行房室结消融术。术前先进行逆行冠状静脉窦造影了解冠状静脉窦分支血管分布 ,然后将起搏电极导线分别置于右心房、右心室及冠状静脉窦分支血管起搏左心室 ,慢性房颤患者仅进行左、右心室起搏。观察双心室起搏前后左心室射血分数变化以及体表心电图QRS波变化。结果　双心室同步起搏后 ,患者心功能得到明确改善 ,左心室射血分数从 (2 6 1± 7 6) % ,提高至 (34 2± 8 9) % (P <0 0 5) ,左心室充盈时间延长 ,二尖瓣反流量减少。心功能平均改善Ⅰ级。QRS波时限由术前的 (1 4 3 1± 1 9 4)ms缩短至 (1 2 4 8± 1 6 7)ms(P <0 0 5)。结论初步临床观察提示 ,双心室同步起搏可有效改善慢性心衰伴心室内传导延迟患者的近期心功能 。Objective To observe the clinical effect of biventricular pacing in patients with chronic heart failure Methods The investigation included 56 patients, 43 male and 13 female, mean age of 52 9 years, with refractory chronic heart failure and left bundle branch block The mean QRS width was (143 1±19 4) ms All of them received biventricular synchronous pacing and the coronary sinus lead was inserted into the branch of coronary sinus to pace left ventricle Results After biventricular synchronous pacing, the heart function was significantly improved The LVEF was increased from 26 1% to 34 2%( P <0 05) The left ventricular filling time was increased and mitral regurgitation was reduced The NYHA class of the patients was improved from class Ⅲ-Ⅳ to class Ⅱ-Ⅲ Conclusion The biventricular synchronous pacing can improve hemodynamic effect in patients with chronic heart failure and left bundle branch block

关 键 词：充血性 临床观察 人工 临床效果 心室再同步起搏 治疗 慢性心力衰竭 室内传导延迟 

分 类 号：R541.6[医药卫生—心血管疾病]