不同病因老年心力衰竭患者心脏再同步化治疗术后心脏的电学重构与机械重构

发布时间：2018-06-24 04:46

本文选题：心脏再同步化治疗 + 心力衰竭　；参考：《中国老年学杂志》2017年03期

【摘要】：目的探讨不同病因心力衰竭的老年患者心脏再同步化治疗(CRT)术后心脏的电学重构和机械重构效应,并且比较不同病因心力衰竭患者接受CRT后短期及长期疗效的差别。方法选取因心力衰竭药物治疗无效而住院行CRT的老年患者50例,其中缺血性心肌病11例,非缺血性心肌病39例。分别对其术前、术后1、6个月进行电学重构指标、机械重构指标检测并随访其短期及长期的疗效。电学重构指标包括心电图P波、PR间期、起搏QRS间期、自身QRS间期、校正QT间期值(QTc)及QT离散度(QTd);机械重构指标包括超声心动图左心室射血分数(LVEF)、左房前后径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末容积(LVESV)、肺动脉压(PAP)、室间机械延迟(IVMD)、左室间隔与后壁运动延迟(SPWMD)。结果 50例老年心力衰竭患者均成功完成CRT。随访6个月至5年,平均随访(2.13±1.25)年,随访过程中共10例患者死亡。非缺血性心肌病组和缺血性心肌病组术后1个月时各项电学重构及机械重构指标无显著差异(P0.05);但术后6个月时两组指标表现出显著差异(P0.05),缺血性心肌病组的电学重构及机械重构效应明显低于非缺血性心肌病组(P0.05)。同时两组患者的5年生存率亦有显著差异(P0.05),非缺血性心肌病组长期生存率明显好于缺血性心肌病组(P0.05)。结论非缺血性心肌病与缺血性心肌病两组患者在接受CRT治疗后短期临床效果相类似,但长期随访临床效果有显著性差异,非缺血性心肌病组患者CRT术后的电学重构及机械重构效应明显好于缺血性心肌病组患者,非缺血性心肌病组患者行CRT的有效率亦明显好于缺血性心肌病组患者。
[Abstract]:Objective to investigate the effects of electrical and mechanical remodeling on cardiac remodeling after cardiac resynchronization therapy (CRT) in elderly patients with heart failure of different etiology, and to compare the short- and long-term effects of CRT in patients with different causes of heart failure. Methods 50 elderly patients with CRT were selected, including 11 patients with ischemic cardiomyopathy and 39 patients with non-ischemic cardiomyopathy. Electrical remodeling index and mechanical remodeling index were measured before, 1 and 6 months after operation, and the short and long term curative effect were followed up. The parameters of electrical remodeling include P wave PR interval, pacing QRS interval, self QRS interval. The parameters of mechanical remodeling include left ventricular ejection fraction (LVEF), left atrial anterior and posterior diameter (lad), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), pulmonary artery pressure (PAP), interventricular mechanical delay (IVMD), left ventricular end-systolic volume (LVESV), pulmonary artery pressure (PAP), interventricular mechanical delay (IVMD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), pulmonary artery pressure (PAP), interventricular mechanical delay (IVMD). Ventricular septal and posterior wall motion delay (SPWMD). Results CRT was successfully completed in 50 elderly patients with heart failure. The patients were followed up for 6 months to 5 years with an average of (2.13 卤1.25) years. 10 patients died during the follow-up. There was no significant difference in electrical remodeling and mechanical remodeling between non-ischemic cardiomyopathy group and ischemic cardiomyopathy group one month after operation (P0.05), but at 6 months after operation, there were significant differences between two groups (P0.05), and electrical parameters in ischemic cardiomyopathy group showed significant difference (P0.05). The effect of remodeling and mechanical remodeling was significantly lower than that of non-ischemic cardiomyopathy (P0.05). At the same time, the 5-year survival rate of the two groups was significantly different (P0.05), the long-term survival rate of non-ischemic cardiomyopathy group was significantly better than that of ischemic cardiomyopathy group (P0.05). Conclusion the short-term clinical effects of non-ischemic cardiomyopathy and ischemic cardiomyopathy were similar after CRT treatment, but there was significant difference in long-term follow-up. The effect of electrical and mechanical remodeling after CRT in patients with non-ischemic cardiomyopathy was significantly better than that in patients with ischemic cardiomyopathy, and the effective rate of CRT in patients with non-ischemic cardiomyopathy was significantly better than that in patients with ischemic cardiomyopathy.
【作者单位】：天津市胸科医院心内科;
【分类号】：R541.6

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