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心脏再同步治疗在窄QRS波慢性心力衰竭患者的疗效观察

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第1期
页码:
75-77
栏目:
临床研究
出版日期:
2010-01-04

文章信息/Info

Title:
Clinical observation of cardiac resynchronization therapy for chronic heart failure patients with narrow QRS complexes
作者:
朱丹军; 薛小临; 王东琦; 孙超峰; 韩克; 崔长琮
西安交通大学医学院第一附属医院心内科、环境与疾病相关基因教育部重点实验室离子通道病研究室，陕西 西安 710061
Author(s):
ZHU Dan-jun;  XUE Xiao-lin;  WANG Dong-qi;  SUN Chao-feng;  HAN Ke;  CUI Chang-cong
Department of Cardiology, First Affiliated Hospital, Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China
关键词:
心力衰竭; 慢性; 心脏再同步治疗
Keywords:
chronic heart failure;  cardiac resynchronization therapy
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的: 观察窄QRS波慢性心力衰竭(CHF)患者的双心室再同步治疗的临床疗效。方法: 筛选16例窄QRS波CHF患者行双心室再同步治疗，所有病例均经冠状静脉窦植入左心室导线至心脏静脉,术后平均随访1~43个月，平均13个月，观察心功能、左心室射血分数、二尖瓣反流面积、左心室舒张末和收缩末内径等的变化。结果: 16例患者治疗后心功能明显改善，有效率75%，心功能从Ⅲ~Ⅳ级 (NYHA分级)改善为Ⅱ~Ⅲ级，左心室射血分数从(0.31±0.11)%提高至(0.38±0.10)%，P<0.05，每搏输出量从(74±8)ml提高至(96±4)ml，P<0.05，二尖瓣反流面积从(8±4)cm2减少至(6±3)cm2，P<0.05，左心室舒张末内径、收缩末内径虽有缩小趋势但没有显著差异［(69±7)mm vs.(68±9)mm；(59±10)mm vs.(56±11)mm］。结论: 双心室再同步治疗对某些窄QRS波CHF患者同样有效。
Abstract:
AIM: To investigate the clinical effect of cardiac resynchronization therapy for chronic heart failure patients with narrow QRS complexes. METHODS: Sixteen chronic heart failure patients with narrow QRS complexes received cardiac resynchronization therapy with left ventricle lead implanted into appropriate cardiac coronary vein. RESULTS: Cardiac function of 16 individuals was significantly improved after treatment. NYHA class of the patients improved from class III-IV to class II-III. After treatment, left ventricular ejection fraction (LVEF) significantly increased ［(0.31± 0.11)% vs.(0.38±0.10)%, P<0.05］ and the cardiac stroke volume (SV) also significantly increased ［(74±8) ml vs.(96±4) ml, P<0.05］. Mitral regurgitation (MR) significantly diminished (8±4)cm2 vs.(6±3)cm2, P<0.05］ and left ventricular end diastolic diameter (LVEDD) and left systolic diameter (LVESD) decreased (69±7)mm vs.(68±9)mm, (59±10)mm vs.(56±11)mm, P>0.05］. CONCUSION: These results suggest that cardiac resynchronization therapy is effective for some chronic heart failure patients with narrow QRS complexes.

参考文献/References

［1］ Swedberg K, Cleland J, Dargie H, et al. Guidelines of diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of European Society of Cardiology［J］. Eur Heart J, 2005, 26(11):1115-1140.

［2］ Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure［J］. N Engl J Med, 2002, 346(24):1845-1853.

［3］ Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure［J］. N Engl J Med, 2005, 352(15):1539-1549.

［4］ 华伟,王方正,张澍,等. 心脏再同步治疗缺血性与非缺血性心脏病的临床应用［J］ . 中华心律失常学杂志, 2005, 9(6):405-408.

［5］ De Cock CC, Van Campen LM, Jessurun ER, et al. Long-term follow-up of patients with refractory heart failure and myocardial ischemia treated with cardiac resynchronization therapy［J］. Pacing Clin Electrophysiol, 2005, 28(Suppl 1):S8-S10.

［6］　Bleeker GB, Schalij MJ, Molhoek SG, et al. Relationship between QRS duration and left ventricular dyssynchrony in patients with end-stage heart failure［J］. J Cardiovasc Electrophysiol, 2004, 15(5):544-549.

［7］　Yu CM, Chan YS, Zhang Q, et al. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography［J］. J Am Coll Cardiol, 2006, 48(11):2251-2257.

备注/Memo

备注/Memo:
收稿日期：2008-12-29.作者简介:朱丹军,主治医师,博士Email:zhudanjun9@hotmail.com
更新日期/Last Update: 2010-01-05