心脏再同步化治疗慢性心力衰竭的临床疗效观察

摘要

目的 观察心脏再同步化治疗慢性心力衰竭的临床效果,探讨心脏再同步化治疗机制及目前存在问题.方法 选择43例药物治疗无效的严重心力衰竭患者进行三腔起搏器治疗,其中4例患者安装双心室同步房室顺序起搏自动复律除颤器,分别观察患者术前、术后3个月、术后6个月的QRS波时限、射血分数、左室舒张末期内径、左右室同步性差值、B型脑钠肽水平及6分钟步行距离的变化.结果 随访3～6个月,1例患者发生猝死,其余患者术后心功能的各项指标与术前相比均有明显改善(P＜0.05).结论 心脏再同步化治疗能显著改善药物治疗无效的慢性心力衰竭患者的心功能不全症状.%Objective To observe the clinical effect of cardiac resynchronization therapy for chronic heart failure,and explore the current problems and mechanism of cardiac resynchronization therapy. Methods This study included 43 cases of patients with severe heart failure who were ineffective by drug therapy. All patients were treated by implantation of triloculare pacemaker, among which 4 patients were implanted with implantable cardioverter defibrillator(ICD). QRS duration,EF value,left ventricular end-diastolic diameter, synchronism difference of left and right ventricles, BNP and 6 min walking were observed before operation as well as three and six months after operation, to assess the clinical effect of cardiac resynchronization therapy. Results After 3 ~ 6 months follow-up, every cardiac function index of patients was improved(P <0.05) after operation,when compared to that before operation. Moreover,the improvement of cardiac function was more significant with the process of follow-up. One patients died of sudden death during the follow-up. Conclusion Assessment of clinical effect suggest that cardiac resynchronization therapy can obviously improve the cardiac dysfunction of patients with chronic heart failure.