心脏再同步治疗10例慢性心衰的短期临床疗效

目的观察双心室同步起搏治疗对药物难治性充血性心力衰竭的短期治疗效果。方法10例悼性心力衰竭患者，心功能（NYHA分级）III-Ⅳ级，QRS时限≥120ms，左室射血分数（LVEF）≤35％，左室舒张末期内径（LVEDD）≥55mm，伴二尖瓣反流。经多种抗心力衰竭药物治疗无效后行双心室同步起搏治疗，其中2例安装三腔埋藏式心脏复律除颤器（CRT-D）。观察术前、术后1个月的NYHA心功能分级、QRS时限、左心室射血分数（LVEF）、左心室舒张末内径（LVEDD）。结果除1例患者未能成功植入左室电极外，其余9例手术顺利，无并发症。其中1例患者术后1月余再次因心衰加重入院，术后心功能平均改善I-Ⅱ级，射血分数、左心室舒张末内径较术前有明显改善（均P〈0．05）。结论双心室起搏心脏再同步化治疗可明显改善慢性心力衰竭伴心室内传导延迟患者的血流动力学、心功能和心力衰竭的临床症状，是治疗顽固性心力衰竭的有效方法之一。

The Clinical Efficacy of Treating 10 Chronic Congestive Heart Failure Patients by Biventricular Synchronous Pacing

Objective To assess the short-term clinical efficacy of treating drug-refractory congestive heart failure patients by biventricnlar synchronous pacing. Methods Of the 10 chronic heart failure patients, NYHA of cardiac function was III - IV grade;time frame of QRS was 120 ms or more;LVEF was 35% or less;LVEDD was 55mm or more;with mitral regurgitation. The patients were treated by biventricular synchronous pacing after the failure treatment of variety anti-heart failure drugs, two of which were installed CRT-D. The indexes of NYHA of cardiac function, time frame of QRS, LVEF and LVEDD were compared before and after the operation. Results Of the 10 patients,9 were operated successfnlly without complication,with only 1 was unsuc- cessfully implanted of the left ventricular electrode. One of the patients was hospitalized due to worsening heart failure about one month after operation. Compared with the status before operation, the cardiac function was improved I - II grade;both LVEF and LVEDD were improved obviously after operation. The P values of statistical analysis of all the indexes were all less than 0. 05. Conclusion Biventricular synchronous pacing can obviously improve clinical symptom of hemodynamic, cardiac function and heart failure of chronic heart failure with intraventricular conduction delay patients. It was one of effective treatments towards refractory heart failure.