双心室起搏预防高度房室传导阻滞患者心功能不全的临床研究

发布时间：2018-03-16 23:18

  本文选题：房室传导阻滞　切入点：心脏再同步化治疗　出处：《南京医科大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：探索双心室(BIV)起搏和右室心尖部(RVA)起搏对高度房室传导阻滞(AVB)患者心脏结构与功能的影响。方法：2009年5月至2012年12月间,采用随机、双盲、平行对照的方法在华东6家医院的心内科连续登记118例高度AVB患者行心脏再同步化治疗(CRT),双心室起搏一周后根据区组随机化1：1程控分为BIV组(CRT-on)和RVA组(CRT-off),评价术后6和12个月患者因心力衰竭(HF)住院次数、心房颤动(AF)负荷、纽约心功能分级(NYHA)、6 min步行距离(6MWD)、明尼苏达心力衰竭生活质量评分(MLHF评分)、左心室射血分数(LVEF)、心室各腔容积和内径及N末端脑钠肽原(NT-proBNP)等指标。结果：共纳入114例成功植入CRT的患者。双心室起搏1周时总体NYHAIⅢ级的比例[25.44%(29/114)VS 9.65%(11/114)]、MLHF评分(17.1±13.6 VS 26.9±21.6)、6MWD[(315.4±121.8)m VS (291.8±102.9)m]和NT-proBNP[157.0 (70.0,639.0) VS 444.7(144.0,1546.0)]较术前均改善(P均0.05)。随机程控分为BIV和RVA组,每组57例,基线特征匹配。随访12个月两组HF住院次数和AF负荷无差异；NYHA、6MWD和MLHF评分与术前相比有改善；与术后1周相比,NT-proBNP浓度BIV组无变化而RVA组有上升趋势,6个月时两组的变化值[3.3(-13.4,37.2)VS60(-18.1,248)]有差异(P=0.045)；各随访点LVEF, BIV组较术前有增加趋势,6个月变化值(BIV3.18±6.79%VS RVA-1.41±6.44%,P0.05);与术后1周相比,左室舒张末期容积变化(△LVEDV, RV9.09±29.30ml VS BIV-16.68±24.30ml, P0.05)和内径变化(△LVEDD, RV2.36±9.32mm VS BIV-1.75±5.79mm,P0.05),BIV组缩小更明显。结论：CRT起搏治疗可早期改善高度AVB患者的心脏功能；随访12个月,双心室起搏改善左室射血分数、缩小舒张末期左室心腔比右心室心尖部起搏更显著。
[Abstract]:Objective: To explore the biventricular (BIV) pacing and right ventricular apex (RVA) pacing on high degree atrioventricular block (AVB) affect the structure and function of patients with heart. Methods: from May 2009 to December 2012, a randomized, double-blind, parallel control method of continuous registration in East China 6 Hospital Department of Cardiology 118 cases of high AVB patients with cardiac resynchronization therapy (CRT), biventricular pacing after a week according to the randomized controlled 1:1 were divided into BIV group (CRT-on) and RVA group (CRT-off), was evaluated after 6 and 12 months for patients with heart failure hospitalization (HF), atrial fibrillation (AF) load, the heart of New York function classification (NYHA), 6 min walking distance (6MWD), the quality of life of heart failure Minnesota score (MLHF score), left ventricular ejection fraction (LVEF), ventricular cavity volume and diameter and N terminal brain natriuretic peptide (NT-proBNP) and other indicators. Results: 114 cases of patients with CRT implantation were included double. 蹇冨�よ捣鎼�1鍛ㄦ椂鎬讳綋NYHAI鈪㈢骇鐨勬瘮渚媅25.44%(29/114)VS 9.65%(11/114)],MLHF璇勫垎(17.1卤13.6 VS 26.9卤21.6),6MWD[(315.4卤121.8)m VS (291.8卤102.9)m]鍜孨T-proBNP[157.0 (70.0,639.0) VS 444.7(144.0,1546.0)]杈冩湳鍓嶅潎鏀瑰杽(P鍧，

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