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目的:以心室收缩不同步作为心脏再同步化治疗的筛选标准,观察心脏再同步化(cardiac resynchronization therapy,CRT)治疗慢性心力衰竭(CHF)的临床疗效。方法:26例CHF患者经过严格的超声筛选后行CRT,全部患者均经冠状静脉窦植入左心室电极,电极位置尽量与超声提示的左心室收缩最延迟部位一致,术后随访(13.8±10.4)个月。结果:2例患者随访中死亡,其余24例患者治疗后心功能、患者活动度、心率变异性均明显改善(P<0.05),左心室舒张末内径从(77.0±9.4)mm缩小至(68.7±10.2)mm(P<0.05),左心室内各室壁收缩期达峰时间标准差从(48.4±17.9)ms减少至(30.2±18.6)ms(P<0.05)。术后1个月左心室16,12及6节段达最小容积点时间的标准差和最大时间差均有明显减低(P<0.05)。结论:CRT是CHF治疗的有效方法,术前应用常规超声心动图及组织多普勒成像技术(TDI)等多项技术来评价患者心室运动的失同步是CRT的有效筛选手段。
OBJECTIVE: To observe the clinical effect of cardiac resynchronization therapy (CRT) on chronic heart failure (CHF) by using asynchrony of ventricular systole as a screening criterion for cardiac resynchronization therapy. Methods: Twenty-six patients with CHF underwent rigorous ultrasound screening before CRT. All patients underwent coronary sinus implantation of left ventricular electrode. The electrode location was consistent with the most delayed ventricular systolic left ventricular ultrasound prompt. The follow-up was 13.8 ± 10.4 ) Months. Results: Two patients died at follow-up. The remaining 24 patients showed significant improvement in cardiac function, patient activity and heart rate variability (P <0.05), and left ventricular end diastolic diameter reduced from (77.0 ± 9.4) mm to (68.7 (P <0.05). The standard deviation of the peak systolic time of each ventricular wall in the left ventricle decreased from (48.4 ± 17.9) ms to (30.2 ± 18.6) ms (P <0.05). At 1 month after operation, the standard deviation and the maximum time difference between the minimum volume points in the 16,12 and 6 segments of the left ventricle were significantly decreased (P <0.05). Conclusion: CRT is an effective method for the treatment of CHF. Preoperative evaluation of ventricular loss of synchronism by conventional echocardiography and tissue Doppler imaging (TDI) is an effective screening method for CRT.