心脏再同步化治疗慢性心力衰竭的临床体会

目的观察心脏再同步化（CRT）和心脏再同步化除颤器（CRT—D）治疗慢性心力衰竭的疗效及并发症发生情况。方法选择药物治疗无效的慢性心力衰竭患者15例，男性10例，女性5例，平均年龄（57．2±9．4）岁。行心脏再同步化治疗，6例置入CRT，9例置入CRT—D，观察起搏器伤口及临床症状、体征，随访心电图、胸部X片、超声心动图，评估疗效。结果置入CRT患者中1例8个月后猝死；1例术后1个月出现膈肌跳动，再次手术1个月后仍有膈肌跳动，关闭左室电极，之后失访。置入CRT—D患者中2例发生持续性室速，自动除颤成功；1例术后15个月死于肺部感染；1例术后14个月出现囊袋皮肤发黑，清创后在同侧胸大肌下方置入原起搏器；1例术后19个月出现囊袋破溃，取出起搏器后5d死于室颤。剔除失访1例，术后6个月10例患者临床指标、超声测定指标好转，心功能改善，有效率71．4％。结论CRT能改善大部分慢性心衰患者的心功能，CRT—D对预防猝死有效。再同步化治疗的囊袋相关并发症发生率较高。

Clinical experience of cardiac resynchronization therapy in treatment of chronic heart failure

Objective To observe the efficacy and complications of cardiac resynchronization （CRT） and cardiac resynchronization defibrillation machine （CRT-D） in patients with chronic heart failure. Methods 15 patients, 10 males, 5 females, mean age （57.2±9.4）years, with chronic heart failure and ineffective medicine therapy, received cardiac resynehronization therapy, 6 patients implanted with CRT, 9 patients implanted with CRT- D, observed in pacemaker wound and clinical symptoms, signs, electrocardiogram, chest radiography, ultrasound follow-up heartbeat graph to assess the efficacy. Results Among patients with CRT, I ease had sudden death after 8 months, another case had postoperative diaphragmatic beating after 1 month, and still had diaphragmatic beating after re-operation,lost follow-up after closure of the left ventricular electrode. Among patients with CRT- D, 2 eases had sustained ventricular tachyeardia and automatic defibrillation succeed, 1 case died of lung infection after 15 months postoperatively, 1 case appeared pouch bag skin blackening after 14 months, after debridement and implanted primary pacemaker at the same side of the pectoralis major muscle beneath, 1 ease after the removal of pacemaker pocket breaking after 19 months, died 5 days later of ventricular fibrillation. 10 patients had improved clinical index and improvement of heart function, efficiency is 71.4%. Conclusion CRT can improve the heart function of the majority of patients with chronic heart failure, CRT-D can effectively prevent sudden cardiac death, complication rates of resynchronization therapy associated with capsular bag are higher.