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双心室起搏治疗充血性心力衰竭的临床疗效(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第5期
页码:
420-422
栏目:
临床研究
出版日期:
2003-09-01

文章信息/Info

Title:
Clinical evaluation of the therapeutic efficacy of biventricular pacing in patients with congestive heart failure
作者:
宋耀明; 黄岚; 李爱民; 耿召华
第三军医大学新桥医院心血管内科, 重庆 400037
Author(s):
SONG Yao-ming;  HUANG Lan;  LI Ai-min;  GENG Zhao-hua
Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
关键词:
双心室起搏; 心力衰竭; 充血性; 传导阻滞
Keywords:
biventricular pacing;  heart failure;  congestive;  conduction delay
分类号:
R541.61
DOI:
-
文献标识码:
A
摘要:
目的:观察双室起搏治疗充血性心力衰竭(CHF)的血流动力学及临床效果。方法: CHF 伴室内传导阻滞患者11例均植入双室起搏器, 左室电极导线经冠状静脉窦插入抵达侧或后侧静脉, 以达到左室起搏夺获。手术前、后应用Swan-Ganz 漂浮导管及超声心动图检查, 观察双室起搏的血流动力学及临床效果。结果: 所有病例植入双心室起搏后临床症状改善, 活动耐量增加。心输出量、心脏指数、射血分数均较术前明显改善。肺毛细血管嵌顿压下降, 二尖瓣返流面积减少, 治疗3月后左心室舒张末期直径由75±8mm下降至68±6mm (P<0.05)。结论: 双心室起搏治疗CHF 伴心室内传导阻滞患者, 可明显缓解临床症状, 逆转左心室重塑, 改善心功能。
Abstract:
AIM: To evaluate the clinical and hymodynomic efficacy of biventricular pacing in the treatment of patients with chronic congestive heart failure. METHODS: 11 patients with congestive heart failure and intraventricular conduction delay, ejection fraction < 35% were recruited forbivent ricular pacing therapy. The hemodynamic parameters with biventricular pacing were evaluated by the echocardiography and Swan-Gans catheterization before and after the operation. RESULTS: After the biventricular pacing, the clinical symptoms were improved and cardiac output, cardiac index and LV ejection fraction increased. The wedged pressure of pulmonary capillaries went down; the size of mitral regurgitation was reduced and the left ventricular end-diastolic diameter decreased (75±8vs68±6mm,P< 0.05) after 3 months’ pacing. CONCLUSION: The biventricular pacing reverses left ventricular remodeling and improves the clinical symptoms, cardiac function in patients with congestive heart failure and intraventricular conduction delay.

参考文献/References

[1] Bakker PF, Meijburg H, Dejonge N, et al. Beneficial effects of biventricular pacing in congestive heart failure (abstract) [J] . Pace, 1994, 17:820.

[2] Xiao HB, Gibson DG. Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy [J] . Int J Cardiol, 1996, 53:163-170.

[3] Leclercq C, Cazeau S, LeBreton H, et al. Acute hemodynamic effects of biventricular DDD pacing in patients with eng-stage heart failure [J] . J Am Coll Cardiol, 1998, 32:1825-1831.

[4] Cazeau S, Leclerco C, Lavergne T, et al. Effects of multisites biventricular pacing in patients with heart failure and intraventricular conduction delay [J] . N Engl J Med , 2001, 344:873-880.

[5] Lee TH, Hamilton MA, Stevenson LW, et al. Impact of left ventricular cavity size on survival in advanced heart failure [J] . Am J Cardiol, 1993, 72:672-676.

[6] Konstam MA, Rousseau MF, Kronenberg MW, et al. Effects of the angiotensin converting enzyme inhibitor enalapril on the long-termp rogression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators [J] . Circulation, 1992, 86:431-438.

[7] Zardini M, Tritto M, Bargiggia, et al. The In Sync Italin Registry: analysis of clinical outcome and considerations on the selection of candidates to left ventricular resynchronization [J] . Eur Heart J , 2000, 2(SupplJ):J16-J22.
　

备注/Memo

备注/Memo:
收稿日期：2002-09-16.
更新日期/Last Update: 2003-09-01