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目的:观察左心室(LV)大小和术后急性期收缩压(SBP)变化对心脏再同步化治疗(CRT)疗效的影响。方法:分别于术前及术后6个月评估21例CRT患者的心功能及超声参数。至术后6个月时,NYHA至少下降1级,左室收缩末容积(LVESV)至少降低10%的为CRT反应较好组,余为反应较差组。结果:术后6个月时,反应较好组和其基线期相比左室射血分数(LVEF)显著升高[(32±9)%vs.(45±10)%,P<0.05)]、左室舒张末容积(LVEDV)显著降低[(237±54)ml vs.(151±45)ml,P<0.05]、左室舒张末内径(LVEDD)显著降低[(68±8)mmvs.(55±6)mm,P<0.05]、左室收缩末容积(LVESV)显著降低[(165±46)ml vs.(84±31)ml,P=0.01]、NYHA的分级由术前6/8(III/IV)降至术后11/3(II/III);反应较差组和术前相比有所改善,未达到统计学意义。反应较好组术后7d SBP均显著升高(P<0.05),反应较差组下降。结论:心力衰竭患者CRT治疗反应较好与治疗前左心室较小和术后急性期SBP升高有关联性。
Objective: To observe the effects of left ventricular (LV) size and acute postoperative systolic blood pressure (SBP) on cardiac resynchronization therapy (CRT). Methods: The cardiac function and ultrasound parameters of 21 patients with CRT were evaluated preoperatively and 6 months after surgery. At 6 months after surgery, NYHA decreased by at least grade 1, and LVESV decreased by at least 10% for the CRT group, with more than the worse responses. RESULTS: At 6 months after surgery, LVEF was significantly higher in the response group than in the baseline group [(32 ± 9)% vs (45 ± 10)%, P <0.05) ], Left ventricular end-diastolic volume (LVEDV) decreased significantly [(237 ± 54) ml vs. (151 ± 45) ml, P < (55 ± 6) mm, P <0.05], LVESV decreased significantly ([165 ± 46] ml vs. (84 ± 31) ml, P = 0.01] 6/8 (III / IV) decreased to 11/3 (II / III) after surgery. The poor response group improved compared with that before operation and did not reach statistical significance. SBP significantly increased on the 7th postoperative day (P <0.05) in the response group with good response, but decreased in the poor response group. CONCLUSION: The response to CRT in patients with heart failure is better correlated with the smaller left ventricular volume and the higher SBP level in the acute postoperative period.