心力衰竭的再同步治疗

虽然药物治疗心力衰竭取得了很大的进展,但仍有许多严重的心力衰竭患者疗效不佳,而心脏移植又受到供体的限制.因此,如何提高严重心力衰竭患者的生存率,拓展其治疗途径是目前的研究热点.通过起搏器改善心脏机械运动的协调性即再同步治疗(CRT)心力衰竭已被越来越多的人们所认识和接受.本文就CRT的基础、机制、相关临床实验、适应证、临床思考和存在的问题作一简述.     

心脏再同步治疗心力衰竭的研究进展

心脏再同步治疗的适应证不断拓宽,但即使按指南建议选择患者,仍有部分患者对治疗无反应,本文就心脏再同步治疗适应证的进展及可能的疗效预测指标做一综述。     

心力衰竭心脏再同步治疗的几个热点问题

<正>左心室、右心室同步起搏的心脏再同步治疗(cardiac resynchronization therapy,CRT),可以提高心力衰竭患者存活率,降低病死率,改善症状、生活质量、运动耐量和心功能[1]。无论是否同时置入心律转复除颤器(CRT-D),CRT均可降低心力衰竭人群病死率和死亡率[2]。因此,各种指南一致推荐,对最佳药物治疗无效的适宜心力衰竭患者,CRT无疑是其治疗的首要选择。大量证据支持心功能III级或非卧床的心功能IV级患     

心脏再同步治疗慢性心力衰竭

心脏再同步治疗伴有心室阻滞的难治性心力衰竭是指通过心房同步双心室起搏刺激来纠正心脏的电一机械失同步，从而改善心脏的结构和功能，阻止了心力衰竭的进行性加重。本文介绍了心脏再同步治疗心力衰竭的机制、适应证以及相关的临床试验。     

心脏再同步治疗慢性心力衰竭的中远期疗效观察

目的观察双心室再同步起搏治疗慢性心力衰竭(CHF)的临床疗效。方法28例慢性心力衰竭合并室内阻滞患者行双心室再同步起搏治疗,全部患者均经冠状静脉窦植入左心室导线1根至心脏静脉,术后平均随访20.6个月,观察心功能,QRS波宽度,左心室收缩、舒张末内径,左心室射血分数,二尖瓣反流面积。结果24例患者治疗后心功能改善,有效率85.7%,心功能从Ⅲ~Ⅳ级(NYHA分级)改善为Ⅱ~Ⅲ级,QRS波从(160±58)ms缩短至(132±53)ms,P<0.05,左心室舒张末内径、收缩末内径分别从(73.54±9.96)mm、(64.25±11.32)mm缩小至(68.75±8.63)mm和(58.51±10.78)mm,P<0.01,左心室射血分数从0.23±0.09提高至0.32±0.10,P<0.01,二尖瓣反流面积从(8.03±4.27)cm2减少至(5.15±4.02)cm2,P<0.01。结论双心室再同步起搏是慢性心力衰竭治疗的有效方法。     

心脏再同步治疗慢性心力衰竭

心脏再同步治疗伴有心室阻滞的难治性心力衰竭是指通过心房同步双心室起搏刺激来纠正心脏的电-机械失同步,从而改善心脏的结构和功能,阻止了心力衰竭的进行性加重.本文介绍了心脏再同步治疗心力衰竭的机制、适应证以及相关的临床试验.     

心力衰竭患者心脏再同步治疗时后备除颤功能的必要性

充血性心力衰竭是心内科治疗学上的难题,是使患者丧失工作能力,具有较高患病率和死亡率的严重疾患。随着人口老龄化速度的加快以及心脏疾病尤其是心肌梗死治疗的进展,心力衰竭患者日趋增多。流行病学资料显示:我国成人心力衰竭患者约有400万,全球心力衰竭患病人数高达2250万,且每年新增病例数约200万。尽管近年来药物治疗取得了很大的进展,但仍有相当数量患者疗效不佳。在药物治疗基础上,器械治疗,包括心脏再同步治疗(CRT)和埋藏式心律转复除颤器(implantable cardioverter defibrillator,ICD)以其卓越的疗效已成为心力衰竭的重要治疗手…     

心脏再同步治疗心力衰竭最新研究进展

心脏再同步治疗是一种非药物治疗心力衰竭的新方法。多项临床研究已证实,心脏再同步治疗可以显著改善患者的心功能,提高生活质量,减少患者的病死率及再住院率。     

慢性心力衰竭的心脏再同步起搏治疗

慢性心力衰竭(心衰)是临床相当常见的心血管综合征,是医学上的难题,也是心血管病的主要死亡原因之一。过去十余年中,药物治疗[肾上腺素β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)等]已被证实可降低病死率。尽管使用最佳的药物治疗,仍不能改变相当一部分患者病情进行性加重及预后不良的现实。心脏移植是治疗晚期心衰的有效方法,但由于供体有限及术后抗排异反应的高额医     

心脏再同步治疗慢性心力衰竭的临床疗效

目的观察心脏再同步治疗慢性心力衰竭的临床疗效。方法36例慢性心力衰竭合并室内传导阻滞的患者行双心室再同步起搏治疗。全部患者均经冠状静脉窦植入左心室导线至心脏静脉。治疗后随访12个月,观察心功能,6min步行距离,QRS波宽度,心室间运动延迟,左心室收缩、舒张末内径,左心室射血分数,二尖瓣反流面积。结果31例治疗后心功能改善,有效率86．1％（31／36）。心功能从Ⅲ～Ⅳ级（纽约心脏协会心功能分级）改善为Ⅱ～Ⅲ级;6min步行距离从（362±153）m提高至（528_＋165）m,差异有统计学意义（P〈0．01）;QRS波从（164．74±33．76）ms缩短至（129．45±42．27）ms,差异有统计学意义（P〈0．01）;心室间运动延迟时间从（65．19±21．50）ms缩短至（33．25±13．62）ms,差异有统计学意义（P〈0．01）;左心室舒张末内径从（66．52±10．23）mm缩小至（60．63±9．97）mm（P〈0．05）,左心室收缩末内径从（55．73±10．62）mm缩小至（47．45±11．35）mm,差异有统计学意义（P〈0．01）;左心室射血分数从30．35％±4．69％提高至42．27％±8．40％,差异有统计学意义（P〈0．01）;二尖瓣反流面积从（7．52±3．62）cm2减少至（4．33±2．07）cm2,差异有统计学意义（P〈0．01）。结论心脏再同步治疗是治疗慢性心力衰竭的有效方法,能使心脏活动再同步化,改善心功能。     

失同步心力衰竭与再同步治疗的动物模型

动物模型可用来模拟失同步心力衰竭（DHF）发生发展与心脏再同步治疗（CRT）作用的病理生理过程,对深入探索DHF和CRT的机制具有重要意义。传统的模型以犬类等大型哺乳动物为主,近年来随着技术的进步,用小鼠及大鼠建立DHF和CRT模型的方法也逐渐涌现。本文复习相关文献,对多种DHF和CRT的动物模型制作方法进行综述。     

慢性心力衰竭患者心脏再同步治疗疗效观察

目的随访慢性心力衰竭患者心脏再同步治疗（CRT）的临床疗效。方法入选1999年至2008年行CRT的慢性心力衰竭患者,收集这些患者基线和最后一次临床资料。采集数据包括临床心功能评估,心脏超声学指标和体表心电图QRS时限宽度。结果95例患者行CRT治疗,分为早期组和近期组。早期组随访时间（57±17）个月,随访生存率为66．6％;近期组随访时间（18±10）个月,生存率为89．1％。两组患者CRT治疗后心功能显著提高,但自身状态下体表心电图QRS时限宽度变化差异无统计学意义。随访中患者药物治疗变化明显。结论中长期和短期随访均证实CRT治疗在一部分慢性心力衰竭患者中能提高心功能,但缺乏预测疗效的敏感指标。     

应用心脏再同步除颤器治疗心力衰竭

本文讨论了植入性心律转复除颤器治疗作用及其副作用,在防治心源性猝死方面的主要临床系列研究的结果。也讨论了心脏再同步化治疗充血性心力衰竭的作用及其临床研究的结果和存在的问题。而具有除颤功能的心脏再同步除颤器已经开始进入临床治疗心力衰竭,但是仍然有许多未知领域需要研究予以澄清。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

心力衰竭的进展(13)慢性心力衰竭心脏再同步治疗研究进展(续8)

慢性心力衰竭患者常伴随的QRS波增宽和心脏不同步进一步加重病情。心脏再同步治疗(CRT)可以部分纠正心脏不同步、改善心功能、提高生活质量、降低病死率。本文回顾了CRT的重要研究和指南,介绍了CRT的患者选择、相关临床情况治疗决策的依据和建议,并展望了CRT未来的发展前景。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.