心脏再同步化治疗心力衰竭伴传导阻滞患者的近期随访

目的 观察心脏再同步化治疗（CRT）心力衰竭伴传导阻滞患者心功能改善情况.方法 连续入选在我科住院的终末期心力衰竭患者45例,按照QRS时限、形态分为完全性左束支传导阻滞组、完全性右束支传导阻滞组和非特异性室内传导阻滞组,分别评估、测量三组患者术前及术后6个月的NYHA分级、左室舒张末内径（LVED）、左室射血分数（LVEF）及血浆B型利钠肽（BNP）浓度.结果 完全性左束支传导阻滞组和非特异性室内传导阻滞组患者术后NYHA分级改善（2.8±0.3）级比（3.6±0.2）级,（2.9±0.3）级比（3.5±0.4）级,P＜0.05],LVED缩小（67.2±7.5）mm比（74.2±6.5）mm,（66.4±9.9）mm比（75.8±9.1）mm,P＜0.05],LVEF增大（33.6±7.7）％比（26.6±7.2）％,（44.4±5.1）％比（28.6±5.7）％,P＜0.05],血浆BNP浓度下降（3988.4±628.3）pg/ml比（8542.6±1384.9）pg/ml,（3573.2±749.5）pg/ml比（6666.2±1110.5）pg/ml,P＜0.05];完全性右束支传导阻滞组NYHA分级没有改善（3.3±0.2）级比（3.4±0.3）级,P＞0.05],LVED无变化（61.2±5.0）mm比（62.4±4.3）mm,P＞0.05],LVEF没有增大（35.2±12.3）％比（33.4±11.8）％,P＞0.05],血浆BNP浓度无明显变化（6844.7±774.8）pg/ml比（7558.6±1327.4）pg/ml,P＞0.05].结论 心脏再同步化治疗能够改善完全性左束支传导阻滞及非特异性室内传导阻滞患者的心脏功能,不能改善完全性右束支传导阻滞患者的心脏功能.

The effect of cardiac resynchronization therapy in heart failure patients with conduction block

Objective To evaluate the effect of cardiac resynchronization therapy in heart failure patients with complete left bundle-branch block,complete right bundle-branch block,and non-specific intraventricular conduction block.Methods CRT was implanted in forty-five heart failure patients,according to QRS,the patients were divided into complete left bundle-branch block group,complete right bundle-branch block and nonspecific intraventricular conduction block group.NYHA grade,left ventricular diastolic diameter（LVED）,left ventricular ejection fraction（LVEF） and B-type natriuretic peptides （BNP） of the three group patients were evaluated before cardiac resynchronization therapy and six months after cardiac resynchronization therapy.Results In the complete left bundle-branch block group and non-specific intraventricular conduction block group,after cardiac resynchronization therapy,NYHA grade improved significantly （3.6±0.2） vs （2.8±0.3）,（3.5±0.4） vs （2.9± 0.3）,P〈0.05],LVED become smaller （74.2±6.5）mm vs （67.2±7.5）mm,（75.8±9.1）mm vs （66.4±9.9）mm,P〈0.05],LVEF also improved（26.6±7.2）% vs （33.6±7.7）%,（28.6±5.7）% vs （44.4±5.1）%,P〈0.05],BNP decreased significantly （8542.6 ± 1384.9）pg/ml vs （3988.4 ±628.3）pg/ml,（6666.2 ± 1110.5）pg/ml vs （3573.2 ± 749.5）pg/ml,P〈0.05].However,in the complete right bundle-branch block group,NYHA grade was not improved （3.4±0.3） vs （3.3±0.2）,P〉0.05],LVED do not become smaller （62.4±4.3）mm vs （61.2±5.0）mm,P〉0.05],LVEF was not improved （33.4±11.8）% vs （35.2±12.3）%,P〉0.05],and BNP was not decreased （7558.6±1327.4）pg/ml vs （6844.7±774.8）pg/ml,P〉0.05].Conclusion Cardiac resynchronization therapy could improve left ventricular function in complete left bundle-branch block patients and non-specific intraventricular conduction block patients,however,left ventricular function of complete right bundle-branch block patients were not improved after cardiac