心室同步化重建治疗扩张型心肌病  

Patients of dilated cardiomyopathy treated with ventricular resynchronizition therapy

作　　者：周晗[1] 张嘉莹[1] 高传玉[1] SCANU Patrice 

机构地区：[1]河南省人民医院,河南郑州450003 [2]法国CHU de Caen

出　　处：《山东医药》2003年第28期3-5,共3页Shandong Medical Journal

摘　　要：目的　观察心室同步化重建起搏对扩张型心肌病顽固性充血性心衰的治疗效果。方法　对 12例临床表现为顽固性心衰 ,合并左束支阻滞的扩张型心肌病患者行双心室同步起搏治疗。观察术中、术后 3个月、6个月左室电极的起搏参数 ,以及术前、术后 3个月的 QRS波时限、左室射血分数、左室舒张末内径 (L VDD)、二尖瓣反流量、最大氧摄取量 (VO2 max)与临床症状变化。结果　随访 3～ 2 0个月 ,患者左室电极的起搏阈值、阻抗及感知各参数值稳定 ,起搏功能良好。与术前相比 ,术后 3个月心功能指标均明显改善 (P <0 .0 5 ) ,且随着时间的延长持续改善。随访期间猝死 1例 ,接受心脏移植 1例。结论　心室同步化重建是治疗室间传导异常充血性心衰的有效新方法。三腔起搏器可改善扩张型心肌病患者的血流动力学、心功能和心衰症状。左室电极植入成功率高 ,性能稳定 ,安全可靠。三腔双心室同步房室顺序起搏心脏自动复律除颤器 (ICD)不仅可治疗心衰 ,同时具有良好的抗室性心律失常。Objective To assess the therapeutic effect of synchronous biventricular pacing on drug-refractory congestive heart failure.Methods 12 patients of dilated cardiomyopathy with congestive heartfailure accompanying complete left bundle branch block were selected to receive synchronous biventricular pacing.10 cases were implanted the triple chamber pacemakers with biventricular pacing,2 cases received the defibrillators ICD with biventricular pacing.The pacing parameter of lead in left ventricule,QRS duration,left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter,mitral regurgitation,VO 2max and NYHA class of cardiac function were observed before and after operation up to 20 months.Results All patients were follow-up for 3～20 mouths.The impedance,pacing and sensing thresholds of left ventricular pacing leads were stable after implantation compared with during operation.The pacemaker and ICD function is perfect.LVEF and other parameters of cardiac function have significantly improved three months after implantation compared with before(P<0.05).And these improvements maintain with the prolonging of time.There is one case of sudden death during follow-up,and one patient received cardiac transplantation.Conclusion Ventricular resynchronizition therapy is an effective new method in congestive heart failure with abnormal inter-ventricular conduction.Biventricular pacing can improve the hemodynamics,cardiac function and symptoms of the dilated cardiomyopathy patients.The left ventricular pacing is safe,stable and easy to implant.ICD with biventricular pacing improves symptoms of heart failure and prevents the sudden cardiac death by effectively acting against ventricular arrythmia.

关 键 词：心室同步化重建 治疗 扩张型心肌病 顽固性充血性心力衰竭 心脏起搏 

分 类 号：R654.2[医药卫生—外科学]