单纯左室起搏与双心室起搏治疗慢性心力衰竭的疗效比较

目的比较单纯左室起搏与双心室起搏治疗慢性心力衰竭(CHF)的可行性及临床效果。方法选择窦性心律、NYHA心功能分级Ⅲ~Ⅳ级、左室射血分数(LVEF)≤0.35、QRS波时限≥120 ms的CHF患者36例,成功植入心脏再同步化(CRT)起搏器后,随机分为两组,第一组先以右房左室起搏模式治疗(LV起搏模式)7天,然后以右房双室起搏模式治疗(Biv起搏模式)7天;第二组先以Biv治疗7天,然后以LV治疗7天。收集术前、术后第7天、第14天的临床资料,所有数据应用交叉设计资料方差分析及单变量一般线性模型分析。结果 6 min步行距离、明尼苏达生活质量评分、体表心电图QRS波时限、左室舒张末期内径、左室射血分数、左室间隔部与侧壁基底段收缩期达峰时间差值等6种评价指标的结果相似:评价指标测量值在处理效应即LV、Biv两种起搏模式上、在顺序效应即两种起搏模式顺序上的差异均无统计学意义(P均>0.05);但在阶段效应即术后第7天、第14天两阶段上的差异有统计学意义(P<0.05)。结论单纯左室起搏与双心室起搏治疗CHF的疗效相仿;对窦性心律、完全性左束支传导阻滞的CHF患者,单纯左室起搏可作为CRT的一种选择。

The comparison of the curative effect between the left univentricular pacing and the biventricular pacing in patients with chronic heart failure

Objective To compare the curative effect of the left univentricular pacing with that of the biventricular pacing in patients with chronic heart failure（CHF）. Methods Thirty-six patients who had left ventrieular ejection fraction （LVEF） less than or equal to 0.35, a QRS duration greater than or equal to 0.12 seconds, sinus rhythm and New York Heart Association （NYHA） function Class 11I or ambulatory Class IV heart failure symptoms with optimal medical therapy were divided into two groups randomly after the successful implantation of CRT/CRTD. The first group was wroking first with left univentrlcular pacing for 7 days, then the biventricular pacing for the next 7 days, and the second group was ＂lust the opposite. The clinical data on the 7th day and that on the first 14th day after the implantation of CRT/CRTD were collect- ed. All data were analyzed with the use of analysis of variance （ANOVA） and univariate general linear model analysis in crossover design material. Results Taking 6-minute walk distance, Minnesota quality-of-life score, QRS duration in surface electrocardiogram, left ventrieular end-diastolic dimension, left ventricular ejection fraction and the difference between systolic time to peak from left interventrJcular septum to the basal segment of lateral wall as the efficacy evaluation indexes, the results were similar in the six kinds of assessment indexes. There was no statistically significant difference between the curative effect of the left univentricular pacing and that d the biventrieular pacing. The difference on alternate order that the left univentricular 13aeinK was first workinK for 7 days or the biventrieular 13aeinK was first working for 7 days in the study was not statistically significant. There was statis- tically significant difference between the curative effect on the 7th day and that on the first 14th day after the implantation of CRT/CRTD, and the curative effect on the 14th day was better than that on the first 7th day. ConclusionThe curative effect of the left univentricular pacing in patients with chronic heart failure is similar to that of the biventricular pacing in patients with chronic heart failure. In patients with severe congestive heart failure, sinus rhythm, and left bundlebranch block despite optimal pharmacological treatment, left univentricular pacing is feasible.