心脏再同步治疗在慢性心力衰竭患者的临床应用

目的评价心脏再同步治疗（cardiac resynchronization therapy，CRT）慢性心力衰竭患者临床应用效果。方法将植入三腔起搏器进行cR王的32名慢性心力衰竭患者根据纽约心脏病学会（New Yor kHeart Association，NYHA）心功能分级分为NYHA心功能Ⅲ级组和。科Y}骆心功能Ⅳ级组。其中NYHA心功能Ⅲ级组14例，NYHA心功能Ⅳ级组18例，并对其进行随访观察治疗，以观察两组患者心功能改善情况，以评价心脏再同步治疗的效果。结果两组在性别构成比、年龄、基础心脏病构成比、左心室射血分数（1础ventricular ejection fraction，LVEF）、术前左室舒张末期内径（1eft ventricular end-diastolic diameter，LVEDD）、植入时心律为窦性心律、术前心电图QRS波时限、术后心电图QRS波时限、左室电极植入靶静脉、植入起搏器类型，及合并糖尿病、高血压病、脑血管疾病史等方面未有统计学差异。术后随访发现，NYHA心功能Ⅳ级组治疗效果明显比例显著低于NYHA心功能Ⅲ级组（5仉O％t】s92．9％，P=0．019）。回顾性分析治疗效果明显与治疗效果不明显两组临床资料，发现治疗效果不明显组NYHA心功能Ⅳ级所占比例明显高于治疗效果明显组（90．O％铘40．9％，P=0．019），且术前LVEDD明显大于治疗效果明显组（76．7±10．3）mmvs（68．0±7．6）mm，P=0．012）]。结论NYHA心功能Ⅳ级组CRT后效果不如NYHA心功能Ⅲ级组，较大的术前LVEDD是CRT术后疗效不佳的预测因素。但在药物治疗基础上，CRT仍可改善慢性心力衰竭患者的心功能。

Application of cardiac resynchronization therapy in chronic heart failure patients

Objective To evaluate the effect of cardiac resynchronization therapy on chronic heart failure patients. Methods Thirty two patients with chronic heart failure who received cardiac resynchronization therapy were divided into the New York Heart Association （ NY- HA） heart function Ⅲ group（ n = 18 ）and NYHA heart function Ⅳ group（ n = 14）. Clinical data were collected during follow-up to evalu ate the effect of cardiac resynchronization therapy. Results There were not statistical difference between two groups in gender composi tion ratio, age, basic heart disease constituent ratio, LVEF （Left ventricular ejection fraction）, LVEDD （left ventricular end-diastolic di ameter）, sinus rhythm, preoperative and postoperation duration of QRS wave, left ventrieular electrode implanted target vein, the type of pacemaker implantation, diabetes mellitus, hypertension, cerebrovascular disease history. Compared with NYHA heart function Ⅲ group, the treatment effect obvious ratio in NYHA heart function IV group was significantly lower in the postoperative follow-up（50.0% vs 92.9%, P = 0.019）. Retrospective analysis of treatment effect＇obvious and treatment be not obvious clinical data of the two groups had found that in the treatment effect be not obvious group , NYHA functional class IV proportion was significantly higher than the treatment effect obvious group （90.0% vs 40.9%, P = 0.019）, and preoperative LVEDD was significantly greater than the treatment effect obvious group （76.7 ＋ 10.3 ） mm vs （ 68.0 ＋ 7.6 ） mm, P = 0.012 ） ]. Conclusions There were lower treatment effect ratio of postoperative CRT in NYHA heart function IV group , compared with NYHA functional class Ⅲ group. The larger preoperative LVEDD was poor effica- cy predictors responding to CRT. However, on the basis of the medication, CRT still improved cardiac function in patients with chronic heart failure.