摘要
目的观察双心室同步起搏治疗慢性心力衰竭(心衰)患者的长期疗效及死亡率.方法 2001年3月至2005年2月住院患者25例,男18例,女7例,年龄34～75(61.42±10.36)岁;其中扩张性心肌病16例,高血压性心脏病3例,缺血性心肌病6例,心功能NYHA分级Ⅲ级10例、Ⅳ级15例.所有患者左室舒张末期内径(LVEDD)>60 mm,左室射血分数(LVEF)<0.40,QRS>130 ms.观察术前及术后3个月、6个月、1年、2年、3年的心功能各项参数及死亡率,平均随访时间为(20.88±11.51)个月.结果 (1)死亡率:死亡5例,非心原性死亡3例,心原性猝死1例,急性心肌梗死1例.(2)术后3个月至3年,平均6 min步行距离明显增加(P<0.01).(3)NYHA心功能分级,术后3个月至3年,心功能明显改善(P<0.01),平均心功能降低1级以上.(4)LVEDD:术后3个月至3年,LVEDD明显减小(P<0.05～P<0.01).(5)LVEF:术后3个月至2年,LVEF明显增加(P<0.05～P<0.01);术后第3年 ,LVEF也改善,但差异无统计学意义.结论双心室同步起搏治疗宽QRS慢性心衰能明显改善患者的生活质量及心功能,减少LVEDD,逆转左室重构,长期治疗疗效巩固,并能降低心衰导致的病死率.
Objective To study the long-term effects and mortality of biventricular pacing therapy in patients With congestive heart failure. Methods Twenty-five patients, 18 men and 7 women, aged 34-75 [ mean aged of （61.42 ± 10. 36 ） ] years, with a cardiac function of New York Heart Association （NYHA） class Ⅲ （n = 10） or Ⅳ （n = 15） received biventricular pacing therapy from Mar. 2001 to Feb. 2005. The etiologies of heart failure were idiopathic dilated cardiomyopathy （16 cases）, hypertensive heart disease （3 cases） and ischemic heart disease （6 cases）. Left ventricular end-diastolic dimension （LVEDD） was 〉 60 mm, Left ventricular ejection fraction （LVEF） was 〈 0. 40 and QRS duration was 〉 130 ms in all the patients. Heart function parameters were repeatedly measured before and 3 months, 6 months, 1 year, 2 years and 3 years after pacemaker implantation. Mortality was also determined. The average follow up period was （ 20. 88 ± 11.51 ） months. Results （ 1 ） Mortality： 5 patients died during follow-up （3 non-cardiac and 1 cardiac sadden death and 1 acute myocardial infarction）. （2）The mean 6-min walking distance was increased significantly （P 〈 0. 05 ） at 3 months to 3 years of follow-up. （ 3 ） NYHA class ： The cardiac function of all patients improved significantly, with a reduction of mean NYHA class of more than one grade at 3 months to 3 years follow-up. （4） LVEDD： LVEDD reduced significantly （P 〈0. 05） at 3 months to 3 years follow-up. （5） LVEF： LVEF increased significantly （ P 〈 0. 05 ） at 3 months to 2 years follow-up. LVEF also improved at third year＇s follow-up, but the difference was not significant statistically. Conclusions Cardiac resynchronization, a pacemaker-based therapy for heart failure, may enhance quality of life and heart function and reverse LV remodeling. The long-term effects of treatment were stable, leading to the reduction of mortality from advanced heart failure.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2005年第8期717-719,共3页
Chinese Journal of Cardiology
