摘要
观察右房 左室起搏治疗慢性心力衰竭 (简称心衰 )的临床效果。选择 1 6例充血性心衰患者 (NYHA分级Ⅲ Ⅳ级 ) ,男 1 0例、女 6例 ,年龄 6 8.4± 6岁 ;均为窦性心律 ,合并有Ⅰ度房室阻滞 ,完全性左束支阻滞。按安置起搏器的模式分为右房 左室起搏治疗组 (LV组 ,n =6 ) ,右房双室起搏治疗组 (BiV组 ,n =1 0 )。左室起搏电极分别放置于心大静脉左室侧后分支 9例 ,心大静脉左室后分支 7例。观察起搏治疗前后左室心功能参数、6min步行距离、左室壁运动的同步性及体表心电图的变化。结果 :BiV组左室射血分数 (LVEF)由术前的 0 .2 3提高至 0 .31 (P <0 .0 0 1 ) ;在LV组LVEF由术前的 0 .2 4提高至 0 .33(P <0 .0 0 1 ) ;左室舒张末期容积指数在二组分别由术前的 1 4 9± 5 1ml/m2 和 1 5 3±5 3ml/m2 下降至 1 1 6± 38ml/m2 和 1 2 1± 4 1ml/m2 (P均 <0 .0 0 1 ) ;室间隔与左室后壁运动的延迟时间在二组分别由术前的 1 95± 94ms和 1 97± 89ms下降至 1 7± 6 0ms及 1 6± 5 6ms(P均 <0 .0 0 1 )。 6min步行距离则分别由术前的4 0 3± 5 3m和 4 0 1± 5 9m提高至 4 4 1± 6 2m和 4 4 2± 6 7m(P均 <0 .0 5 )。结论 :初步临床观察提示右房 左室起搏治疗与右房双室起搏治疗相比 ,同样可有效地改善慢性心衰?
To study the clinical effect of right atrial left ventricular pacing therapy in patients with chronic heart failure,16 patients ,10 male and 6 female,mean ages of 72 years,with refractory chronic heart failure and left bundle branch block were investigated. All of them were sinus rhythms. The mean QRS width was 140～190 ms; The mean of left ventricular ejection fraction(LVEF) was 0.23.10 of them received biventricular synchronous pacing(BiV group, n=10),6 of them received right atrial left ventricular pacing (LV group,n=6)and the coronary sinus lead was inserted into the branch of coronary sinus to pace left ventricular. Results:After biventricular synchronous pacing and right atrial left ventricular pacing, the heart function was significantly improved. In the BiV Group,the LVEF was increasd from 0.23 to 0.31( P<0.05). In the LV Group,the LVEF was increasd from 0.24 to 0.33( P<0.05);The left ventricular end diastolic volume index was decreased from 149±51 ml/m 2 and 153±53 ml/m 2to 116±38 ml/m 2及121±41 ml/m 2 respectively,(P<0.001).The the septal to posterior wall motion delay,a left intraventricular asynchrony parameter, was decreased from 195±94 ms(BiV group)and 197±89 ms(LV group) to 17±60 ms and 16±56 ms respectively(P<0.001).The 6 min walk distance increased from 403±53 m(BiV group) and 401±59 m(LV group) to 441±62 m and 442±67 m respectively(P<0.001).Conclusion:The right atrial left ventricular pacing therapy can improve hemodynamic effect in patients with chronic heart failure and left bundle branch block.
出处
《中国心脏起搏与心电生理杂志》
2004年第3期175-177,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
心力衰竭
充血性
左室起搏
起搏部位
Cardiology Heart failure, congestive Left ventricular pacing Pacing site
