多点组合再同步心脏起搏治疗伴有心室传导阻滞的难治性心力衰竭的临床效果

目的 探讨多点组合再同步心脏起搏治疗伴有心室传导阻滞的难治性心力衰竭的临床效果.方法 以河南省胸科医院收治的60例经药物治疗无效的难治性心力衰竭患者为研究对象,完全随机分为对照组和观察组,各30例对照组采用常规的抗心力衰竭药物治疗,观察组在抗心力衰竭药物的基础上,依据患者病情,分别植入右心房、有心室和冠状静脉左心室分支电极导线,以行房室顺序双心室同步起搏.分别记录治疗前后QRS时限、左心室舒张末内径（LVEDD）、左心室射血分数（LVEF）、纽约心脏病协会（NYHA）心功能分级和6 min步行试验情况.结果 观察组患者治疗前QRS时限为（187±13）ms,对照组为（188±15）ms;观察组患者的NYHA分级为（3.7±0.5）,对照组为（3.7±0.5）,2组NYHA分级比较差异无统计学意义（P＞0.05） 经过治疗,观察组患者的QRS时限为（131 ±11）ms,明显优于对照组的（180±12）ms,差异有统计学意义（P＜0.05）,而观察组的NYHA分级在治疗后为（2.3±0.5）,对照组为（3.0±0.5）,差异有统计学意义（P＜0.05）,观察组患者治疗后的LVEDD、LVEF、6 min步行距离分别为（64 ±6） mm、（34±7）％、（398±147）m,明显优于对照组的（73 ±8） mm、（25±8）％、（256±136）m,差异均有统计学意义（均P＜0.05）.结论 采用多点组合再同步心脏起搏的方法治疗伴有心室传导阻滞的难治性心力衰竭,临床效果明显优于药物治疗,患者心功能明显好转,心脏射血分数增加.

Clinical effects of treating refractory heart failure associated with ventricular conduction block with multi point combination of cardiac resynchronization therapy

Objective To observe and analyze the clinical effects of treating refractory heart failure associated with ventricular conduction block with multi point combination of cardiac resynchronization therapy.Methods Sixty cases with refractory heart failure after drug treatment in our hospital were chosen as study objects and were randomly divided into two groups according to the calculator method：the control group（30 cases） and the observation group（30 cases）.The control group was given only conventional drug therapy for heart failure,the observation group was implanted into the right atrium,right ventricle and left ventricular coronary vein branch electrode wire,the atrioventricular sequential biventricular pacing on the basic of the heart failure drugs according to the illness.Before and after treatment,left ventricular ejection fraction （LVEF）,New York heart association （NYHA） cardiac functional grading and 6 min were walking were noted.Results The QRS time limits before treatment of observation group patients was （187 ± 13）ms,while of the control group patients was （188 ± 15）ms,the NYHA grading of observation group was（3.7 ±0.5）,which was the same as control group,the differences had no statistical significance（P ＞ 0.05）.After treatment,the QRS time limits of observation group （180 ± 12）ms] was significantly better than control group （131 ± 11） ms],the differences were statistically significant （P ＜ 0.05）,and the NYHA grading of observation group was （2.3 ± 0.5） while the control group was （3.0 ± 0.5）,with statistical significance（P ＜ 0.05）,the LVEDD,LVEF and walking distance in 6 min of observation group were （64 ± 6） mm,（34 ± 7）％,（398± 147）m respectively,which was much better than the control group of （73 ± 8）mm,（25±8）％,（256±136）m,the differences were statistically significant（P＜0.05）.Conclusion The multipoint combination of cardiac resynchronization therapy on refractory heart failure associated with ventricular conduction block has better clinical effect than the drug treatment group by improving heart function of the patients and increase cardiac ejection fraction.