应用双心室起搏治疗顽固性心力衰竭

目的：观察双心室起搏治疗顽固性心力衰竭的效果。方法：对8例心功能Ⅲ-Ⅳ级,左心室射血分散≤35％,QRS波时限＞0．12秒,伴有二尖瓣反流的顽固性心力衰竭患者行三腔双心室起搏治疗,观察术后心功能改善和生存质量改善情况。结果：术后10天临床症状改善,6分钟步行距离增加,左心室射血分数增加,二尖瓣反流消失或缓解,左心室内径缩小,QRS波时减少。二个月后随访临床症状进一步改善,生活质量提高。结论：双心室起搏治疗顽固性心力衰竭能缓解症状,改善心功能。     

双心室同步起搏治疗顽固性心力衰竭的临床研究

目的：观察双心室同步起搏对扩张型心肌病顽固性心力衰竭的治疗效果。方法：10例扩张型心肌病病人，男6例，女4例，所有病人符合NYHA心功能Ⅲ—Ⅳ级，心电图呈窦性心律，完全性左束支传导阻滞，QRS时限〉120ms，射血分数〈35％。左室内径〉60mm。因严重心力衰竭而长期卧床，经多种抗心衰药物治疗效果不佳。分别植入右心房、右心室和冠状静脉左室分支电极导线，行房室顺序双心室同步起搏，观察起搏前、后QRS时限、NYHA心功能分级、左室内径、射血分数及6min步行试验的变化。结果：右心房、右心室和左心室电极导线感知和起搏参数均符合起搏要求。起搏后QRS时间明显缩短（P〈0．01），（NYHA）心功能分级进一步改善（P〈0．01），左室射血分数及6min步行增加（P〈0．01）。结论：双心室同步起搏治疗可缓解心衰的症状，改善心功能，增加射血分数，提高运动耐量。     

双心室起搏治疗心力衰竭的临床观察

[目的]观察双心室起搏治疗心力衰竭临床疗效。[方法]经左锁骨下静脉穿刺送入Attain冠状静脉窦(CS)长鞘,在CS导管的导引下,将鞘送人CS,用Attain球囊造影导管进行心脏静脉逆行造影,将左心室电极经长鞘放入选择的静脉,送人右心室及右心房电极至右室心尖和右心耳。与三腔脉冲发生器连接,脉冲发生器埋藏于左上胸皮下。[结果]3例均患者无电极脱位,无膈肌刺激。但1例术前有尖端扭转性室性心动过速伴阿-斯综合征患者,于术后6月在医院外因心室颤动而猝死。[结论]CHF伴室内阻滞的患者经双心室起搏治疗后,临床症状和心功能明显改善,LVEF提高,心脏缩小,与多中心结果相似。     

应用双心室起搏治疗顽固性心力衰竭

目的观察双心室起搏治疗顽固性心力衰竭的效果.方法对8例心功能Ⅲ～Ⅳ级,左心室射血分数≤35%,QRS波时限＞0.12秒,伴有二尖瓣反流的顽固性心力衰竭患者行三腔双心室起搏治疗,观察术后心功能改善和生存质量改善情况.结果术后10天临床症状改善,6分钟步行距离增加,左心室射血分数增加,二尖瓣反流消失或缓解,左心室内径缩小,QRS波时减少.二个月后随访临床症状进一步改善,生活质量提高.结论双心室起搏治疗顽固性心力衰竭能缓解症状,改善心功能.     

双心室同步起搏治疗充血性心力衰竭

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 ,具有较高死亡率的严重疾患 ,每年有成千上万的患者死于心力衰竭。充血性心力衰竭的临床症状主要由于右心室扩大 ,心功能减退 ,心输量减少造成 ,相当一部分患者往往合并房室传导或心室内传导延迟 ,进一步加重心力衰竭。目前的主要治疗以药物为主 ,包括应用强心、利尿、扩血管药物 ,以减轻心脏的前负荷、后负荷及增加心脏收缩力。虽然应用药物可缓解症状 ,但仍有相当数量的患者 ,既便应用最佳的药物治疗 ,仍不能改变心功能衰竭进行性加重及改善预后。近几年来 ,国际上进行了一系…     

双心室起搏治疗心力衰竭的临床应用(附三例报告)

目的评价双心室起搏治疗充血性心力衰竭的临床疗效。方法3例伴左束枝阻滞或室内阻滞的难治性充血性心力衰竭患者,男2人,女1人,平均年龄67岁,所有患者植入三腔双心室起搏器,左室电极经冠状窦置入冠状静脉侧支或后侧支。结果手术全部成功。三名患者于植入后临床症状明显改善,6分钟步行距离延长,体表心电图QRS时限由166±25ms缩短至110±8.2ms。随访10～18个月,超声心动图示左室射血分数由32.6±3.3%增至44.6±5.2%。但二例病人在随访期间,死于心室颤动。结论双心室起搏可以改善难治性充血性心力衰竭患者的临床症状,提高生活质量,改善心脏功能。     

多腔起搏-心室再同步化治疗心力衰竭进展

尽管近年来慢性充血性心力衰竭(ＣＨＦ)的治疗有了很大的进展 ,特别是血管紧张素转换酶抑制剂和倍他受体阻滞剂的临床应用 ,使得许多心衰患者的生存质量和寿命均有显著改善。然而心衰的发病率不断上升 ,死亡人数的逐渐增加 ,且重症心衰的年死亡率仍高达5 0 % ,等待心脏移植的病人仍不断增长 ,心脏供体的缺乏 ,无法满足患者需要。采用心脏起搏方法来治疗心衰是近几年来刚兴起的新技术[1] ,目前国际上还处于初步探索、研究阶段 ,但双心室起搏(ＢＩＶＰ)治疗心衰已显示出其光明的前景 ,本文就其研究情况作一介绍。1　起搏治疗心力衰竭的临床及…     

三腔双心室起搏器治疗充血性心力衰竭1例

患者男,58岁,主因间断性胸闷、气短3年,加重伴夜间不能平卧3天,于2003年3月3日入院.心脏彩色超声心动图显示左房内径42.5mm,左室舒张末内径83.7mm,射血分数(EF):19%,CDFI:二尖瓣口左房侧可见重度收缩期返流信号.     

双心室同步起搏治疗难治性心力衰竭的临床疗效观察

目的：报道16例三腔双心室同步起搏治疗难治性心力衰竭患者的疗效观察，探讨多部位起搏治疗心力衰竭的临床经验。方法：12例原发病为扩张性心肌病及4例原发病为缺血性心肌病的难治性心力衰竭患者，植入双心室同步起搏器。全部患者术前1周接受常规心电图、超声心动图、临床心功能评价等作为基础对照，术后1周、3个月在重复上述检查。结果：16例患者均顺利完成起搏器植入术，患者的心电图显示QRS时限较术前缩短，临床评价及超声测定的心功能情况明显改善。结论：双心室同步起搏能使难治性心力衰竭患者的双心室收缩达到同步化，从而改善患者的心功能。     

双心室起搏治疗充血性心力衰竭的效果

目的 探讨双心室起搏治疗充血性心力衰竭的临床效果.方法 选取2016年1月至2018年10月在南阳市第一人民医院治疗的49例充血性心力衰竭患者,所有患者均接受双心室起搏治疗并随访6个月,对患者术前及术后3个月的活动度、夜间心率进行比较,测定患者各时间点左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、...     

Emerging new frontiers in cardiac pacing: cardiac pacing in heart failure

Indications for pacing have leapt beyond sinus node dysfunction and atrioventricular (AV) block. Pacing for the purpose of improving hemodynamics has become the prime subject of exploration. Several studies have reported hemodynamic and clinical improvement with bi-ventricular pacing and AV sequential pacing. Data is still pouring in from the various ongoing trials regarding the beneficial effects of these methods of pacing. This is especially true in a subset of patients with intractable heart failure. There are several indicators to identify these patients. Those who have intra-ventricular conduction defects and those who demonstrate hemodynamic improvement after temporary pacing are certainly the candidates who will benefit most from this new form of pacing. Prolonged PR interval or left bundle branch block with intractable heart failure also falls into this category. The rationale of pacing in heart failure is to correct the cardiac dysynchrony that occurs frequently in these patients. Cardiac dysynchrony can occur due to ineffective synchronization between atria and ventricles (AV dysynchrony) or due to lack of synchronization within the two ventricles (ventricular dysynchrony). This is overcome by AV sequential pacing or by multi chamber pacing using the coronary sinus as portal of entry of the electrode into the cardiac vein to pace the left ventricle. Pacing leads and generators have been designed to suit the new found methods of pacing. Clinical trials are in full swing to establish the efficacy of these methods.     

Constrictive pericarditis--a rare but important cause of recurrent cardiac failure: a case report

Constrictive pericarditis (CP) is an uncommon cardiac disease which is often difficult to diagnose because of its vague and myriad clinical presentations. We report a case of a middle-aged lady who had non-specific symptoms and signs for six years before she was eventually diagnosed to have idiopathic constrictive pericarditis. An awareness and understanding of this condition is important, as it is a progressive condition and the likelihood of cure depends very much on its early identification and treatment.     

Primary cardiac hemangioendothelioma: a case report

Primary cardiac hemangioendothelioma is extremely rare.1-3 Up to now less than twenty cases have been reported in English literature, the data about this kind of cardiac tumors are scanty. In this report, a case of a huge hemangio-endothelioma that arose from the right atrium and was successfully resected is presented.     

The challenges of cardiac pacing: an illustrative case

The history of transvenous pacing encompasses the past five decades. Multiple lead complications have been described, including problems related to central venous access, venous thrombosis, extravascular bleeding, lead and pacemaker pocket infections, lead fractures, lead dislodgment, lead perforation, diaphragmatic pacing, and chronic lead threshold changes. Potential solutions to these problems have included: improvements in lead composition and tip technology, multiple pacemaker lead and generator insertions, alternative lead sites, pacemaker lead extenders, extraction of infected leads, multiprogrammable pacemaker generators, high output generators, antibiotics and anticoagulants, and venous reconstruction. This case illustrates complications and solutions over a 20-year period. The indications for temporary transfemoral and permanent iliac vein transvenous pacing are reviewed, including a new indication for the iliac venous approach.     

Primary cardiac hemangioendothelioma: a case report

Primary cardiac hemangioendothelioma is extremely rare.1-3 Up to now less than twenty cases have been reported in English literature, the data about this kind of cardiac tumors are scanty. In this report, a case of a huge hemangio- endothelioma that arose from the right atrium and was successfully resected is presented. CASE REPORT A 36-year-old woman who complained of progressive shortness of breath for two years and being difficult on supine position for 2 months was admitted to the ho…     

阿霉素性心肌病一例报告

1临床资料患者,女,36岁.因反复胸闷、气短半年余入院.患者于半年前出现胸闷、气短伴乏力,活动和夜间平卧时加重,咳较频,咳白色泡沫痰,在当地医院查心脏彩超提示全心扩大,射血分数(EF)为35%,B超示双侧心包积液,多次以"扩张性心肌病"治疗效不佳而转入我院.患者过去有急性淋巴细胞性白血病史,行化疗至今,1999年12月至2002年10月间曾用多柔比星(阿霉素)、环磷酰胺等化疗药物,阿霉素总量465 mg/m2.     

Leflunomide-induced acute liver failure: a case report

A 27-year-old male patient with rheumatoid arthritis was diagnosed with acute liver failure when he was taking leflunomide,a new immunosuppressant. This case illustrates the risk that leflunomide may lead to severe hepatotoxicity.     

犬慢性快速右心室起搏构建心衰模型

目的　探讨犬快速右心室起搏构建心衰模型的方法学。方法　采用快频率〔(230±10)次/min〕以VOO方式起搏犬右心室3周,构建实验性心衰模型,观察起搏前、后临床表现。同时应用心脏彩色超声心动图检测起搏前后心功能及心脏形态学变化。结果　5条犬经快速右心室起搏3周均出现呼吸困难、活动减少、体重减轻等临床表现,心脏彩色超声心动图证实左室射血分数由62. 6±4. 77降至44 .4±2. 88 (P<0 .01)。结论　慢性快速右心室起搏是构建心衰模型的有效方法,成功地给犬安植快频率右心室起搏器并确保手术后3周以(230±10)次/min快频率起搏是模型构建成功的关键,选择最理想的手术切口及最佳的囊袋位置在模型构建过程中尤为重要。