【摘要】 目的评价应用Tei指数指导优化房室延迟(AVD)对置入双腔起搏器的心力衰竭患者生活质量和预后的影响。方法 2009年1月至2011年1月在我院心内科拟首次置入双腔起搏器且存在心功能不全的患者162例,按随机数字表法分为对照组(80例)和优化AVD组(82例)。对照组患者置入的起搏器按厂家初始设定的AVD进行工作,优化AVD组患者术后行超声心动图检查,以Tei指数指导优化AVD。置入起搏器12个月后,对所有患者进行6min步行距离测试、超声心动图检查及生活质量评分,并记录随访期间患者死亡、急性肺水肿、心功能恶化入院、恶性心律失常(室性心动过速、心室颤动发作)等主要心脏不良事件(MACE)发生情况。结果优化AVD组患者AVD优化后左心室充盈时间(LVFT)、左心室输出量(LVCO)较优化前改善,且差异均有统计学意义[(363.74±7.57)msvs(342.57±5.34)ms,t=-5.510,P<0.05;(3.09±0.21)L/minvs(2.99±0.19)L/min,t=-2.936,P<0.05]。置入起搏器12个月后,优化AVD组心力衰竭患者6min步行距离、LVFT、左心室射血分数(LVEF)、二尖瓣反流面积和生活质量评分均优于对照组,且差异均有统计学意义[(362.09±27.01)mvs(336.71±20.92)m,t=-6.676,P<0.01;(362.76±6.47)msvs(342.63±4.42)ms,t=-10.650,P<0.01;(48.09±2.49)%vs(46.35±2.16)%,t=-4.754,P<0.01;(1.36±0.26)cm2vs(1.52±0.35)cm2,t=3.434,P<0.05;(108.40±7.40)分vs(102.80±5.80)分,t=-5.291,P<0.01]。优化AVD组患者累积无MACE生存率为90.2%(74/82),对照组患者为77.5%(62/80),差异有统计学意义(χ2=4.628,P=0.031)。结论应用Tei指数指导优化AVD能减轻置入双腔起搏器的心力衰竭患者心功能损害程度,提高患者生活质量,并改善预后。更多还原

【Abstract】 Objective To investigate the effects of optimizing atrioventricular delay (AVD) by using Tei index on the prognosis and quality of life(QOL) in chronic heart failure (CHF)patients with implanted dual chamber pacemaker.Methods Totally 162 CHF patients implanted DDD or DDDR pacemaker in our department of cardiology from January 2009 to January 2011 were enrolled and randomly divided into two groups: control group included 80 cases and optimized AVD group included 82 cases. Patients in optimized AVD group attained their optimum AVD by using Tei index within 1 month postoperatively. All patients were followed up for 12 months,then echocardiography,6 minutes walk distance and QOL were performed and the results were compared between the two groups. The major adverse cardiac events (MACE) of patients during follow-up period were recorded.Results The left ventricular filling time(LVFT),left ventricular cardiac output(LVCO) of patients in optimized AVD group were improved after using Tei index to optimize AVD[(363.74±7.57)ms vs (342.57±5.34)ms,t=-5.510,P<0.05;(3.09±0.21)L/min vs (2.99±0.19)L/min,t=-2.936,P<0.05]. After following up for 12 months, patients in optimized AVD group had improvement in distance of 6 minutes walk,LVFT, LVCO, left ventricular ejection fraction(LVEF), mitral valve regurgitation area and QOL compared with control group[(362.09±27.01)m vs (336.71±20.92)m,t=-6.676,P<0.01;(362.76±6.47)ms vs (342.63±4.42)ms,t=-10.650,P<0.01;(48.09±2.49)% vs (46.35±2.16)%,t=-4.754,P<0.01;(1.36±0.26)cm2 vs (1.52±0.35)cm2,t=3.434,P<0.05;(108.4±7.4)scores vs (102.8±5.8)scores,t=-5.291,P<0.01]. And Kaplan-Meier survival analysis showed that patients in optimized AVD group had higher cumulative non-events survival rates(90.2% vs 77.5%,χ2=4.628,P=0.031).Conclusion Optimizing AVD under guidance of Tei index in patients with heart failure that implanted dual chamber pacemaker can reduce the extent of heart failure,improve quality of life and clinical prognosis.更多还原