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目的:提高对心力衰竭中的心脏变时性功能不全因素的认识。方法:回顾性分析2例心力衰竭伴心脏变时性功能不全患者并复习有关文献。结果:例1重度肥胖患者,以喘促为主症,经呼吸机、利尿剂、血管紧张素转换酶抑制剂及抗感染等治疗,疗效欠佳,心率60次/min左右,心脏彩超左心功能测定:SV54ml,EF60%,CO4.1L/min,CI1.8L·min-1·m-2,予静滴异丙肾上腺素提升心率,心衰得到迅速改善。例2下壁、侧壁心肌梗死并休克,予多巴胺及多巴酚丁胺强心、补液、IABP治疗,效果不佳,心率保持在60次/分以上水平,后加用临时起搏器提升心率至80～100次/min,不显著,放弃治疗。结论:变时性是心脏电活动和心脏节律方面的一个重要功能,是评价心脏功能的一个动态指标,变时性功能不全可导致或加重心力衰竭,是一种未被充分认识的重要因素和类型,提升心率是治疗该类心衰的重要措施之一。
OBJECTIVE: To raise awareness of factors that contribute to chronotropic impaired heart failure. Methods: A retrospective analysis of 2 cases of heart failure patients with cardiac dysfunction and review of the literature. Results: In patients with severe obesity, wheezing was the main symptom. After treatment with ventilator, diuretic, angiotensin converting enzyme inhibitor and anti-infective, the curative effect was poor. The heart rate was 60 beats / min, Function determination: SV54ml, EF60%, CO4.1L / min, CI1.8L · min-1 · m-2, to intravenous isoproterenol to enhance heart rate, heart failure was rapidly improved. Example 2 inferior wall, side wall myocardial infarction and shock, to dopamine and dobutamine cardiac, rehydration, IABP treatment, the effect is not good, keep the heart rate at 60 beats / min or more, then add a temporary pacemaker to enhance Heart rate to 80 to 100 beats / min, not significant, to give up treatment. CONCLUSIONS: Timeliness is an important function of cardiac electrical activity and heart rhythm and a dynamic indicator of cardiac function. Chronic dysfunction can lead to or worsen heart failure, which is an important factor that is not fully understood. Type, improve heart rate is one of the important measures for the treatment of such heart failure.