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目的:观察心室再同步(CRT)起搏治疗慢性心力衰竭(CHF)的长期疗效及病死率。方法:49例CHF患者中,男40例,女9例,年龄31～82(56.3±11.0)岁。均有严重器质性心脏病,心功能(NYHA分级)Ⅲ～Ⅳ级,其中扩张型心肌病36例,缺血性心肌病9例,高血压性心脏病4例。所有患者心电图为窦性心律,ORS波>130ms,左室舒张末期内径(LVEDD)>60mm,左室射血分数(LVEF)<35%伴二尖瓣反流。49例中置入CRT40例,置入CRT心脏复律除颤器(CRT-D)9例。观察患者起搏器置入前,置入后1、3、6、12、24、36、48、60个月的心功能各项参数、生活质量(QOL)评分以及术后并发症、病死率与心血管事件。随访12～87(25.5±15.6)个月。结果:①并发症:电极脱位4例,囊袋出血2例;②病死率及死因:死亡15例(30.6%),其中CHF恶化死亡7例,心性猝死6例,非心源性死亡2例,49例患者中12例(24.5%)21次发生室性心动过速(VT)/心室颤动(Vf),其中3例CRT-D患者发生12次VT/Vf均被CRT-D成功纠治,3例CRT患者各发生1次VT/Vf经体外除颤纠治,6例CRT患者各因发生1次VT/Vf死亡;③心功能变化及QOL评分:37例(75.5%)患者LVEF、6min步行距离、心功能NYHA分级等心功能评价指标术后持续改善,11例(22.4%)患者心功能评价指标术后改善后再次恶化,1例无明显变化;49例患者QOL评分均较术前提高,LVEDD术后12个月明显缩小。结论:CRT治疗CHF能明显改善患者心功能,提高生活质量、6min步行距离、LVEF,缩小LVEDD,逆转左室重构;长期治疗,疗效巩固并能降低CHF导致的病死率,CRT-D可同时防治CHF及猝死事件的发生。
Objective: To observe the long-term efficacy and mortality of ventricular resynchronization (CRT) pacing in patients with chronic heart failure (CHF). Methods: Among 49 CHF patients, 40 were male and 9 were female, ranging in age from 31 to 82 (56.3 ± 11.0) years. All had severe organic heart disease, cardiac function (NYHA classification) Ⅲ ~ Ⅳ level, including 36 cases of dilated cardiomyopathy, ischemic cardiomyopathy in 9 cases, 4 cases of hypertensive heart disease. All patients had sinus rhythm with an ORS> 130 ms, LVEDD> 60 mm, and LVEF <35% with mitral regurgitation. Among the 49 cases, 40 cases were treated with CRT and 9 cases with CRT cardioverter-defibrillator (CRT-D). The parameters of cardiac function, quality of life (QOL) score, postoperative complications and mortality were observed before and at 1, 3, 6, 12, 24, 36, 48 and 60 months after implantation With cardiovascular events. The follow-up ranged from 12 to 87 (25.5 ± 15.6) months. Results: ① Complications: Electrode dislocation in 4 cases and capsular bag hemorrhage in 2 cases; ② Case fatality rate and cause of death: 15 cases died (30.6%), including 7 cases of CHF worsening death, 6 cases of sudden cardiac death and 2 cases of noncardiac death , 12 (24.5%) of 49 patients developed ventricular tachycardia (VT) and ventricular fibrillation (Vf) 21 times. Of the 3 patients, 12 VT / Vf were successfully treated by CRT-D , VT / Vf were treated by external defibrillation once in each of 3 patients with CRT. One patient died of VT / Vf in each of the 6 patients with CRT. (3) The changes of cardiac function and QOL score: LVEF in 37 patients (75.5%), 6min walking distance, heart function NYHA classification and other cardiac function evaluation indicators continued to improve after surgery, 11 patients (22.4%) patients with cardiac function index improved again after worsening, 1 case no significant change; 49 patients QOL scores were more surgery Before the increase, LVEDD significantly reduced after 12 months. CRT can significantly improve cardiac function and improve quality of life in patients with CRT, 6min walk distance, LVEF, LVEDD reduction, reverse left ventricular remodeling; long-term treatment, the effect of consolidation and can reduce the mortality caused by CHF, CRT-D at the same time Prevention and treatment of CHF and sudden death.