影响心脏再同步治疗反应性的相关因素的回顾性分析

发布时间：2018-05-21 16:59

  本文选题：心衰 + 心脏再同步治疗　； 参考：《兰州大学》2017年硕士论文

【摘要】：目的:经过大量多中心、随机、双盲临床试验证实,心脏再同步治疗能改善心衰患者临床症状、提高射血分数、保证生活质量、降低心衰住院率及全因死亡率。近些年来,随着操作人员技术的熟练、符合条件患者数目的增加以及指南的更新,接受心脏再同步治疗的患者明显增加。但在筛选的患者中仍有20%-30%对心脏再同步治疗无反应,加上CRT花费较大,这限制了CRT的临床应用,造成了医疗资源的浪费,也给患者造成了过多的经济负担。本文旨在探讨影响心脏再同步治疗预后的相关因素,并明确可预测CRT反应性的独立相关因素。方法:回顾性分析了2009年1月1日-2015年12月31日在兰州军区兰州总医院成接受心脏再同步治疗的患者。所有患者均满足最佳药物治疗下NYHA分级(Ⅱ-Ⅳ级)、严重损害的左室收缩功能(LVEF35%)、延长的QRS时限120ms。以术后12个月时心脏彩超LVEF值对≥5%,且术后12月内无因心衰住院及无全因死亡为有反应。结果:研究共纳入82例慢性心衰患者,CRT有反应59例(71.95%),无反应23例(28.05%)。统计了每例患者的基本特征、基础疾病、有无房颤、基础肾功能、红细胞分布宽度等信息。所得统计结果通过logistic回归分析,逐步回归纳入研究变量,通过Wald检验,0.05为检验水准,共筛选出3个暴露因素纳入logistic回归模型,并解释统计结果:CRT有反应的保护因素为LBBB,危险因素为慢性房颤、基础肾功能减退。结论:LBBB、房颤、基础肾功能为CRT反应性的独立相关因素;合并LBBB的患者对CRT的反应性较好,而房颤、基础肾功能障碍(GFR60ml·min-1·1.73m-2)会降低患者对CRT的反应性。
[Abstract]:Objective: a large number of multicenter, randomized, double-blind clinical trials have proved that cardiac resynchronization therapy can improve clinical symptoms, improve ejection fraction, ensure quality of life, reduce hospitalization rate and all-cause mortality of heart failure patients. In recent years, the number of patients receiving cardiac resynchronization has increased significantly with skilled operators, increased number of eligible patients and updated guidelines. However, 20% to 30% of the selected patients still have no response to cardiac resynchronization therapy, and CRT costs a lot, which limits the clinical application of CRT, resulting in a waste of medical resources and too much economic burden for patients. The purpose of this study was to investigate the prognostic factors of cardiac resynchronization therapy and to determine the independent correlation factors for predicting CRT reactivity. Methods: the patients receiving cardiac resynchronization in Lanzhou General Hospital of Lanzhou military region from January 1, 2009 to December 31, 2015 were retrospectively analyzed. All the patients were satisfied with the NYHA grade (grade 鈪，

本文编号：1920021