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目的 :旨在观察心脏再同步化治疗(CRT)对合并左心室收缩功能不全的三度房室传导阻滞(AVB)患者左心室重构的影响。方法 :选取2009-01至2014-10在本院接受CRT的三度AVB患者49例,分别于术前、术后6个月和12个月行超声心动图检查,测定左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、二尖瓣反流(MR)分级等多项指标,观察心脏结构及功能变化情况。结果 :49例患者术后LVEF逐渐上升,与术前相比,术后6个月LVEF增加(4.92±5.24)%(P<0.05),术后12个月LVEF较术后6个月进一步增加(5.02±6.52)%(P<0.05);LVESV较术前逐渐降低,术后6个月LVESV下降(25.02±17.95)ml(P<0.05),12个月时LVEVS较术后6个月进一步下降(24.79±22.49)ml(P<0.05);其他指标亦有改善,与术前相比,术后6个月LVEDV下降(25.61±24.24)ml(P<0.05),LVEDD下降(3.22±2.91)mm(P<0.05),LVESD下降(4.43±2.86)mm(P<0.05),MR分级下降(0.49±0.76)级(P<0.05),上述指标在术后12个月进一步降低,与术后6个月对比,LVEDV下降(28.18±22.36)ml(P<0.05),LVEDD下降(4.17±3.14)mm(P<0.05),LVESD下降(4.92±4.40)mm(P<0.01),MR分级下降(0.22±0.55)级(P<0.05)。结论 :CRT可逆转合并收缩功能不全的三度AVB患者的左心室重构,改善心功能。
Objective: To investigate the effect of cardiac resynchronization therapy (CRT) on left ventricular remodeling in patients with third degree atrioventricular block (AVB) with left ventricular systolic dysfunction. Methods: Forty-nine patients with third degree AVB who underwent CRT in our hospital from January 2009 to October 2014 were examined by echocardiography before operation, 6 months and 12 months after operation, respectively. The left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) and mitral regurgitation Indicators, observation of cardiac structure and function changes. Results: The LVEF of 49 patients increased gradually after operation, the LVEF increased by 4.92 ± 5.24% at 6 months after operation (P <0.05), and the LVEF increased further at 6 months after operation (5.02 ± 6.52)%, respectively (P <0.05). LVESV decreased gradually compared with that before operation, LVESV decreased 25.02 ± 17.95 ml at 6 months after operation (P <0.05), and LVEVS at 12 months (24.79 ± 22.49) ml (P <0.05). Other indexes also improved. LVEDV decreased (25.61 ± 24.24) ml (P <0.05) and LVEDD decreased (3.22 ± 2.91) ) (P <0.05), LVESD decreased (4.43 ± 2.86) mm (P <0.05), and MR classification decreased (0.49 ± 0.76) (P <0.05). The above indexes were further reduced at 12 months After 6 months, LVEDV decreased (28.18 ± 22.36) ml (P <0.05), LVEDD decreased (4.17 ± 3.14) mm, LVESD decreased (4.92 ± 4.40) mm Decreased (0.22 ± 0.55) grade (P <0.05). Conclusion: CRT can reverse left ventricular remodeling and improve cardiac function in patients with third degree AVB with systolic dysfunction.