单左心室起搏通过频率适应性房室延迟改善慢性充血性心力衰竭患者血流动力学的效果研究

发布时间：2018-05-13 07:41

本文选题：心力衰竭 + 心脏再同步疗法　；参考：《中国全科医学》2017年02期

【摘要】：目的应用双腔起搏器单左心室起搏频率适应性房室延迟(RAAVD)功能跟踪生理性的房室延迟,探索单左心室起搏RAAVD功能实现双心室收缩再同步化治疗慢性充血性心力衰竭(CHF)患者血流动力学的效果。方法选取2013年3月—2016年3月昆明医科大学第一附属医院心内科收治的CHF患者68例,采用随机数字表法将患者分为单左心室起搏RAAVD组(采用单左心室起搏RAAVD模式)和标准双心室起搏组(采用标准双心室起搏模式),各34例。测定两组患者心脏再同步治疗(CRT)术前、术后超声心动图指标,包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左房室瓣反流面积(MRA)、主动脉瓣前向血流速度时间积分(AVVTI)、E-A峰间距(E/A Pd)、心室间机械延迟时间(IVMD)以及12节段达峰时间标准差(Ts-SD12)。结果所有患者在植入起搏器后无血气胸、囊袋感染等并发症发生。术后平均随访时间为(17.3±9.6)个月,单左心室起搏RAAVD组在随访过程中1例患者死亡,标准双心室起搏组在随访过程中3例患者死亡。单左心室起搏RAAVD组和标准双心室起搏组术后LVEF、LVEDD、E/A Pd、Ts-SD12比较,差异均无统计学意义(P0.05);单左心室起搏RAAVD组术后MRA、IVMD低于标准双心室起搏组,AVVTI高于标准双心室起搏组(P0.05)。单左心室起搏RAAVD组和标准双心室起搏组术后LVEF、AVVTI均高于术前,术后LVEDD、MRA、Ts-SD12均低于术前(P0.05);单左心室起搏RAAVD组术后IVMD低于术前(P0.05)。结论应用单左心室起搏RAAVD功能,实现了安全、可行的生理性起搏,使得双心室收缩再同步,改善CHF患者的血流动力学,效果不劣于标准双心室起搏。
[Abstract]:Objective to track the physiologic atrioventricular delay with dual chamber pacemaker single left ventricular pacing frequency adaptive atrioventricular delay (RAAVD) function. Objective: to explore the effect of single left ventricular pacing (RAAVD) on hemodynamics in patients with chronic congestive heart failure (CHF). Methods from March 2013 to March 2016, 68 patients with CHF were treated in Department of Cardiology, first affiliated Hospital of Kunming Medical University. Patients were randomly divided into single left ventricular pacing group (single left ventricular pacing RAAVD mode) and standard biventricular pacing group (using standard biventricular pacing mode 34 cases each). Echocardiographic parameters were measured before and after cardiac resynchronization therapy in both groups. These include left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDN), left atrioventricular regurgitation area (MRAA), aortic valve forward flow velocity time integral (AVVTI) E-A peak spacing, interventricular mechanical delay time (IVMDD) and 12 segment peak arrival time standard deviation (Ts-SD12). Results there were no complications such as hemopneumothorax and pouch infection after pacemaker implantation in all patients. The average follow-up time was 17. 3 卤9. 6 months. One patient died in the RAAVD group and 3 in the standard biventricular pacing group. There was no significant difference in LVEFV DDE / A PdP Ts-SD12 between the single left ventricular pacing group and the standard biventricular pacing group, and the difference was not statistically significant between the single left ventricular pacing group and the standard biventricular pacing group (P 0.05), and the difference between the single left ventricular pacing group and the standard biventricular pacing group was lower than that in the standard biventricular pacing group (P 0.05), and that in the single left ventricular pacing group was lower than that in the standard biventricular pacing group (P 0.05). In the single left ventricular pacing RAAVD group and the standard biventricular pacing group, the postoperative LVEF VTI was higher, the postoperative LVEDDD MRAT Ts-SD12 was lower than the preoperative P0.05, and the IVMD in the single left ventricular pacing RAAVD group was lower than that in the preoperation (P0.05). Conclusion the application of single left ventricular pacing (RAAVD) can achieve safe and feasible biventricular pacing, make biventricular contraction resynchronization and improve hemodynamics in patients with CHF, and the effect is not inferior to that of standard biventricular pacing.
【作者单位】：昆明医科大学第一附属医院心内科
【基金】：国家自然科学基金资助项目(81360044) 云南省科技厅资助项目(2013FB133)——昆明医科大学联合专项基金
【分类号】：R541.6

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