心脏再同步化治疗慢性心衰的临床观察

目的观察心脏再同步化治疗(CRT)慢性心力衰竭(CHF)患者的临床疗效。方法选择2008年1月至2009年8月行CRT的患者32例,其中12例植入再同步心脏转复除颤器(CRT-D)。32例中30例为窦性心律,2例为房颤心律。随访21.5±6.2个月,观察患者NYHA心功能分级、QRS波时限、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、6分钟步行距离(6MWD)、因心功不全住院时间等。结果 32例植入CRT(D)患者中,有24例临床症状明显改善,心功分级降低,LVEF和6MWD增加,QRS波时限、LVEDD减少,因心功不全住院时间明显减少约24.5%(p<0.05)。8例患者心功能没有明显改善,但因心功不全住院时间减少约8.3%(p<0.05)。4例患者记录到室性心律失常事件(12.5%),2例室速经抗心动过速起搏(ATP)有效转复,2例患者因室颤而放电,均成功转复,CRT-D均能有效识别和转复。结论 CRT可明显改善CHF患者的心功能,提高生活质量,缓解临床症状,植入CRT-D可有效预防心源性猝死(SCD)。

Effects of cardiac resynchronization therapy on the patients with chronic heart failure

Objective To observe and evaluate the effects of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF). Methods From Jan 2008 to Aug 2009, 32 patients with CHF were treated with CRT. 12 patients of them were implanted cardiac resynchronization therapy defibrillator(CRT-D). 30 patients were sinus rhythm, and other 2 were fibrillation atrial. The average follow-up was 21.5±6.2 months. The NYHA class, QRS duration, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), 6 minute walking distance (6MWD) and the average time of hospitalization were evaluated. Results 24 patients showed statistically significant improvements in the symptoms, NYHA class, LVEF, LVEDD, 6MWD and QRS duration. The average time of hospitalization was decreased by 24.5% (p <0.05). The heart failure symptoms of other 8 patients were not improved, but the time of hospitalization was decreased by 8.3%(p<0.05). Ventricular arrhythmia events were recorded and could be effectively reverted to sinus by CRT-D in 4 patients (12.5%). Ventricular tachyarrhythmia could reverted to sinus by antitachycardia pacing(ATP) in 2 patients. The other 2 patients could be defibrillated by shock after fibrillation ventricular. Conclusion CRT did result in significant improvement in quality of life and cardiac function of the patients with CHF. CRT-D can effectively prevent from sudden cardiac death(SCD).