双腔起搏器不同房室间期起搏对心功能影响的研究

探讨双腔起搏器不同房室间期 (AVD)起搏对即时心功能的影响 ,并观察根据即时心功能调定的最佳房室间期对CHF患者长期疗效的影响。用M型和B型超声心动图比较了 6例无心力衰竭DDD起搏者和 14例CHFDDD起搏患者 (其中 13例存在缓慢型心律失常 )不同AVD起搏时心功能参数的变化。 14例CHFDDD起搏患者常规起搏 3个月后随机分为常规起搏组 (7组 )和最佳房室间期起搏组 (7例 ) ,起搏 3个月后随访心功能 (NYHA分级 )和心室腔径的改变。结果 :CHF组和无心力衰竭组不同AVD起搏时各项心功能指标变化均无差异 (P >0 .0 5 ) ;常规起搏组和最佳AVD起搏组起搏 3个月后NYHA分级和心室腔径无显著变化 (P >0 .0 5 )。结论 :经调定的短AVDDDD起搏不能改善CHF患者的心功能和心室重构。不宜将双腔起搏器最佳AVD起搏作为CHF患者的常规非药物疗法 ,对因纠治心脏电学异常而安装DDD起搏器的CHF患者 ,在无其他证据之前仍宜采用常规AVD起搏     

Congestive Heart Failure Treatment: The Pacing Approach

Early reports of physiologic pacing for congestive heart failure (CHF) yielded conflicting results, and little enthusiasm was generated for pacing as a mode of therapy for CHF. Small, uncontrolled studies, which had little or no follow-up demonstrated that pacing from the left ventricle could synchronize contraction of the ventricles and improve overall ventricular performance. These encouraging reports led to a number of larger, multicenter trials, which have been recently reported. These trials have consistently shown improvements in such objective measurements as peak exercise oxygen consumption, ejection fraction, heart rate variability, 6-minute walk test distance and anaerobic threshold, as well as subjective improvements such as quality of life assessment. A number of large, multicenter double-blinded trials are ongoing which will seek to further assess the benefits of biventricular or multisite pacing. Among the important issues, which will be addressed by ongoing trials, are the possibility of pacing induced arrhythmias, the benefit of adding defibrillator capability to these pacing systems, and the development of novel delivery systems, which will make implantation of these systems more accessible to clinicians. Studies to date have largely excluded patients with traditional indications for pacing, and have been confined chiefly to patients with PR interval prolongation, and left bundle branch block with a QRS duration greater than 120 milliseconds, with New York Heart Association class II or III CHF. Whether this therapy will offer benefit to other patients who do not meet these criteria is also unknown at present. Another novel mode of pacing therapy, which may be clinically appropriate for a broader range of CHF patients, is contractility modulation, which involves subthreshold pacing to increase intracellular calcium and enhance inotropy. Early data suggests that the benefits of these two forms of pacing therapy may be additive.     

双室起搏治疗充血性心力衰竭近期疗效研究

为进一步观察双室起搏对充血性心力衰竭 (简称心衰 )治疗的效果 ,对 10例充血性心衰病人置入InSync(三腔 )起搏器 ,并观察术前及术后 3个月临床症状及心功能指标的情况。结果 :置入起搏器术后 3个月 ,心功能明显改善 ,从 3.4 4± 0 .5 2级降至 1.5 0± 0 .72级 (P <0 .0 1) ,心衰症状评分从 8.1± 3.2 9分降至 1.4± 1.74分 (P <0 .0 1) ,左室舒张末期内径从 6 7± 6 .6 8mm减至 6 2 .75± 5 .92mm(P <0 .0 5 ) ,射血分数从 0 .35± 0 .0 7增至 0 .4 3± 0 .10 (P <0 .0 5 )。结论 :双室起搏治疗可明显改善心功能 ,提高病人生活质量 ,逆转左室重塑。     

双心室起搏治疗充血性心力衰竭

探讨双心室起搏技术治疗慢性充血性心力衰竭的临床疗效。 11例充血性心力衰竭患者 ,男 9例、女 2例 ,年龄 5 4± 7岁。心功能 (NYHA)Ⅲ～Ⅳ级 ,均伴有心室内传导阻滞。全部患者置入三腔双心室起搏器 ,左心室电极置于冠状静脉侧支及后侧分支内。结果 :手术全部成功。所有患者于置入后症状改善 ,体表心电图QRS时限由 15 9.8± 4 .4 2ms缩至 130 .5± 3.6 9ms ,P <0 .0 1。随访 6～ 18个月 ,超声心动图显示左室射血分数由 0 .2 5± 0 .0 5增至 0 .38± 0 .0 5 ,P <0 .0 1、舒张期充盈改善、二尖瓣返流减少。结论 :双心室起搏可以改善药物控制困难的伴室内传导阻滞的心衰患者的临床症状 ,改善心功能 ,提高生活质量。     

Effects of Carvedilol on Heart Rate Dynamics in Patients with Congestive Heart Failure

Background: Patients with congestive heart failure (CHF) have alterations in the traditional and nonlinear indices of heart rate (HR) dynamics, which have been associated with an increased risk of mortality. This study was designed to test the effects of carvedilol, a nonselective beta‐blocker with alpha‐1 blocking properties, on HR dynamics in patients with CHF. Methods: We studied 15 patients with CHF secondary to ischemic or idiopathic cardiomyopathy who met the following inclusion criteria: NYHA functional class II‐III, optimal conventional medical therapy, normal sinus rhythm, left ventricular ejection fraction (LVEF) of < 40%, and resting systolic blood pressure greater than 100 mmHg. The 6‐minute corridor walk test, estimation of LVEF, and 24‐hour Holter recording were performed at baseline and after 12 weeks of therapy with carvedilol. Traditional time and frequency domain measures and short‐term fractal scaling exponent of HR dynamics were analyzed. Results: After 12 weeks of therapy with carvedilol, the mean LVEF improved significantly (from 0.27 ± 0.08 to 0.38 ± 0.08, P < 0.001). The average HR decreased significantly (from 86 ± 11 to 70 ± 8 beats/min, P < 0.001). The mean distance traveled in the 6‐minute walk test increased significantly (from 177 ± 44 to 273 ± 55 m, P < 0.01). The frequency‐domain indices (HF and LF), the time domain indices (rMSSD and PNN5), and the short‐term fractal scaling exponent increased significantly. The scaling exponent increased particularly among the patients with the lowest initial values (< 1.0), and the change in the fractal scaling exponent correlated with the change in ejection fraction (r = 0.63, P < 0.01). Conclusion: Carvedilol improves time and frequency domain indices of HR variability and corrects the altered scaling properties of HR dynamics in patients with CHF. It also improves LVEF and functional capacity. These specific changes in HR behavior caused by carvedilol treatment may reflect the normalization of impaired cardiovascular neural regulation of patients with CHF. A.N.E. 2002;7(2):133–138     

不同部位组合起搏对充血性心力衰竭患者急性血流动力学影响的研究

观察右房左室起搏对充血性心力衰竭 (CHF)患者急性血流动力学的影响。 8例心功能II～IV级CHF患者 ,分别置入右房、右室和左室电极 (经冠状静脉窦 ) ,行不同部位组合起搏的急性血流动力学研究 ,其中 6例获得成功。使用Bitronic公司生产的双腔起搏分析仪 (ERA30 0 )分别行单纯右室心尖部 (RVA)、右房右室 (RA +RV)、右房左室 (RA +LV)、右房双室 (RA +BiV)起搏 ,同时用二维超声心动图测定上述四种起搏状况下的血流动力学参数 ,并进行比较。结果 :右房左室起搏和右房双室起搏血流动力学参数两者间无显著差异 ,但比单纯右室心尖部起搏和右房右室起搏有所改善。结论 :右房左室起搏似可使更多的CHF患者在得益于起搏治疗的同时明显降低医疗费用。     

参芪扶正注射液对充血性心力衰竭病人血流动力学的影响

目的观察参芪扶正注射液对充血性心力衰竭(CHF)病人血流动力学的影响。方法将60例CHF病人随机分为参芪扶正组和常规治疗组各30例。常规治疗组给予血管紧张素转换酶抑制剂、利尿剂、洋地黄制剂等常规治疗。参芪扶正组在此基础上加用参芪扶正注射液。两组均治疗14d,治疗前后采用超声心动仪测定左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)和左室射血分数(LVEF)。结果治疗后参芪扶正组LVEDD和LVESD分别为(55.16±5.07)mm和(42.27±7.39)mm,显著低于常规治疗组(60.27±6.41)mm和(50.89±8.31)mm(P<0.01);LVEF为49.25%±8.78%,显著高于常规治疗组40.75%±7.43%(P<0.01)。结论参芪扶正注射液可明显改善CHF病人左心室功能。     

起搏治疗慢性充血性心力衰竭的进展

心脏起搏治疗慢性充血性心力衰竭是非药理学治疗的新方法。已经证实双心室同步起搏可以改善慢性充血性心力衰竭患者的血流动力学、心功能状态和生活质量 ,心脏同步起搏联合心脏内复律除颤器治疗减少了病死率和再住院率 ,相关临床试验仍在进行中。     

Coronary Sinus Flow Reversal in Congestive Heart Failure Detected During Biventricular Pacing

This report describes a phenomenon observed during implantation of a left ventricular lead through the coronary sinus. During coronary sinus venography there was reflux of dye from the coronary sinus ostium towards the distal part of the sinus against the anticipated direction of flow. This was correlated to elevation of the right atrial pressure above the pressure within the coronary sinus. A review of data is provided and suggests several deleterious effects of this phenomenon on left ventricular function.     

卡维地洛治疗心力衰竭的疗效观察

目的 观察卡维地洛对充血性心力衰竭(CHF)的临床疗效。方法 将52例CHF患者随机分为卡维地洛组和常规治疗组，卡维地洛组在常规抗心衰治疗的基础上给予卡维地洛；常规治疗组采用安慰剂加常规抗心衰治疗。结果 卡维地洛治疗5个月后心功能及超声指标与常规治疗组相比均明显改善。结论 卡维地洛对充血性心力衰竭的治疗有显著效果。     

卡维地洛在充血性心力衰竭中的作用

卡维地洛是一种新型的非选择性β受体阻滞剂,许多临床实验证实卡维地洛长期治疗可降低充血性心力衰竭患者死亡率。现对卡维地洛在充血性心力衰竭中的作用进行综述。     

加味参附颗粒对充血性心力衰竭病人血流动力学的影响

目的探讨加味参附颗粒对充血性心力衰竭病人血流动力学的影响及其临床疗效.方法将84例充血性心力衰竭病人分为两组,治疗组在对照组常规治疗的基础上加用加味参附颗粒,两组疗程均为4周.治疗前后观察两组心功能改善情况,同时测定血流动力学指标.结果治疗组总有效率明显优于对照组;两组治疗后的心每搏输出量(SV)、心排血量(CO)、心脏指数(CI)均较治疗前有统计学意义(P＜0.01或P＜0.05),且两组治疗后比较亦有统计学意义(P＜0.05);治疗组治疗后射血分数(EF)、左室短轴缩短率(△D%)、室壁增厚率(△T%)均显著增加(P＜0.05),体循环外周阻力(SVR)明显降低(P＜0.05),对照组上述指标均无明显变化.结论加味参附颗粒能明显改善充血性心力衰竭病人的心功能,与西药合用能取得更好的治疗效果.     

充血性心力衰竭与中枢性睡眠呼吸暂停

中枢性睡眠呼吸暂停在充血性心力衰竭患者中发生率较高,加重心力衰竭患者病情,影响其预后。现就中枢性睡眠呼吸暂停在充血性心力衰竭中的流行病学、病理生理、临床特征、诊断、治疗和预后等方面的研究进展进行综述。     

InSync 8040起搏器在充血性心力衰竭治疗中的初步应用

观察InSync 80 40起搏器治疗扩张型心肌病 (DCM)伴充血性心力衰竭 (CHF)的疗效。 8例DCM伴CHF患者 ,男 7例、女 1例。其中伴完全性左束支阻滞 6例 ,左前分支阻滞、右室起搏后宽QRS波 (>0 .2 0s)各 1例。通过冠状静脉窦置入 2 187电极起搏左室 ,右房电极和左、右室电极分别与InSync 80 40起搏器A、V1、V2 孔相连接。术后起搏阈值 3.75± 0 .6 (3.0～ 5 .0 )V。患者CHF的症状明显改善 ,术后左室舒张末径、左室射血分数、左室短轴缩短率、心胸比例较术前均有改善 (分别为 6 6 .1± 6 .93mmvs 72 .5± 8.1mm、0 .374± 0 .0 31vs 0 .2 81± 0 .0 5 3、19.8%± 2 .2 %vs12 .2 %± 2 .7%、0 .5 9± 0 .4vs 0 .6 4± 0 .2 0 ;P均 <0 .0 5 )。结论 :初步临床应用表明 ,以InSync 80 40起搏器行双心室同步起搏治疗CHF疗效肯定     

充血性心力衰竭的昼夜动态血压特征及临床意义

本文观察了 ４４ 例非瓣膜性充血性心力衰竭（ Ｃ Ｈ Ｆ）患者的昼夜血压变化及其与心功能受损程度的关系。　结果： Ｃ Ｈ Ｆ患者中有 ８１．８％ 血压昼夜节律减弱或消失，这种血压昼夜节律的改变在有高血压史与无高血压史两组间无显著差异。在心功能级的 １１ 例中有 ６ 例（５４．５％ ）发生血压昼夜节律的改变，而心功能级和级的 ３３ 例中则有 ３０ 例（９０．９％ ）。这表明相当一部分的 Ｃ Ｈ Ｆ患者有血压昼夜节律的改变，且与心功能受损的严重程度有一定相关。     

慢性充血性心力衰竭的氨基酸疗法研究

目的研究口服L-精氨酸和瓜氨酸对慢性充血性心力衰竭病人内皮功能的影响。方法用光电体积描记术记录30例确诊病人示指脉搏波。测定口服L-精氨酸和瓜氨酸试验前后静息状态下脉搏波和缺血后每30s时间段的最大脉搏波时长、总时长以及两者之间的比值。结果两组受试者试验前脉搏波无明显差异。口服氨基酸后,每30s时间段的最大脉搏波时长/总时长比值较试验前均有显著差异,试验前后静息状态下脉搏波,L-精氨酸组（38.75±11.52 vs 23.32±6.08,P=0.007）和瓜氨酸组（41.4±13.47 vs 23.65±6.74,P=0.007）。试验前后60～90s时间段,L-精氨酸组（36.60±11.51 vs 18.81±15.13,P=0.004）和瓜氨酸组（49.51±15.17 vs 27.13±7.87,P=0.003）。结论 口服L-精氨酸和瓜氨酸有助于改善内皮功能,减低血压和肺动脉收缩压,辅助治疗慢性充血性心力衰竭。     

扩张性心肌病并心力衰竭患者双室同步起搏治疗对心率变异性的影响

观察双室同步起搏对扩张性心肌病并心力衰竭 (简称心衰 )患者心功能及心率变异性 (HRV)的影响。选择1 5例扩张性心肌病并顽固心衰患者 ,置入双室起搏器 ,观察心功能、HRV及血浆丙二醛、一氧化氮、内皮素 1、血管紧张素 Ⅱ的变化。结果 :心功能NYHA分级从术前 3.32± 0 .31级提高为 2 .1 8± 0 .33级 ,左室射血分数由 0 .2 9± 0 .0 3增至 0 .36± 0 .0 3(P <0 .0 5 ) ;2 4h正常RR间期均值标准差、相邻RR间期差值均方根、相邻RR间期差值 >5 0ms占正常RR间期数的百分比、总功率、低频及高频波段功率分别由 73± 8.1ms、4 1± 8.0ms2 、5 .3%± 1 .5 %、1 0 2 4± 4 1 3ms2 、1 1 5± 35ms2 及 4 8± 1 5ms2 增至 1 0 7± 1 3ms、70± 1 1ms2 、1 1 .3%± 3.4 %、1 92 1± 4 84ms2 、1 94± 35ms2 及 91± 2 9ms2 (P均 <0 .0 1 ) ;血浆丙二醛、内皮素 1分别由 4 31± 37nmol/L、83.1± 2 1ng/L降至 32 3± 2 9nmol/L、6 7.3± 1 6ng/L ,一氧化氮由 38.1± 7.6 μmol/L增至 5 1 .3± 9.2 μmol/L(P均 <0 .0 1 ) ,血管紧张素 Ⅱ无变化 (P >0 .0 5 )。结论 :同步起搏改善扩张性心肌病心衰患者心功能及HRV。     

细胞凋亡与心力衰竭的基础和临床研究进展

心力衰竭心脏存在心肌细胞凋亡,心肌细胞凋亡造成心肌细胞数量减少是心力衰竭发生、发展的原因之一。但心力衰竭中各种诱导凋亡因素如何介导信号凋亡通路还不清楚。针对凋亡发生的各个环节的各种防治方法将是今后一段时间内心力衰竭防治的新途径。     

可溶性细胞黏附分子与充血性心力衰竭

充血性心力衰竭进程中存在着可溶性细胞粘附分子水平明显增加,可能是导致心肌细胞功能衰竭的重要原因之一。就可溶性细胞黏附分子的种类、生物学特征、充血性心力衰竭时血清中的变化及药物的干预作用,提示可溶性黏附分子对充血性心力衰竭的病程进展具有重要意义,减少可溶性细胞黏附分子的过度表达及血浆水平是今后充血性心力衰竭治疗对策的重要内容。