【摘要】 目的分析慢性心力衰竭病人心脏再同步化治疗(CRT)的临床疗效。方法回顾性分析六安市人民医院2013年6月至2017年7月22例慢性心力衰竭病人CRT的临床资料:CRT术前及术后3个月心功能[NYHA心功能分级,6 min步行距离,脑钠肽(BNP)]、心电图(HR,QRS波宽度)、心脏超声[左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左房内径(LA),二尖瓣返流(MR),肺动脉收缩压(PASP),左室射血分数(LVEF)]及血检验指标(Cr,K~+,Na~+)的数据,对上述指标的术前基线值及术后3个月随访值行配对t检验。对病人CRT术前及术后3个月MR评分与LVEDD、LVEF、PASP、LA、6 min步行距离、QRS波宽度的变化趋势进行Pearson相关性分析。结果 (1)术前基线值及术后3个月随访值行配对t检验:治疗前后心功能指标差异有统计学意义(NYHA心功能分级,t=7.172,P<0.001;6 min步行距离,t=-22.448,P<0.001;BNP,t=3.819,P=0.001);治疗前后QRS波宽度差异有统计学意义(t=11.890,P<0.001);治疗前后大部分心脏超声指标差异有统计学意义(LVEDD,t=8.219,P<0.001;LVESD,t=7.611,P<0.001;LA,t=4.780,P<0.001;MR,t=6.394,P<0.001;LVEF,t=-6.759,P<0.001);两组HR、PASP、Cr、K~+、Na~+之间差异无统计学意义。(2)经Pearson相关性分析,CRT术后MR的改善与LVEDD的减小(r=0.496,P=0.019)和LVEF的增加(r=-0.486,P=0.022)呈中等程度相关;与QRS波宽度缩短之间无显著相关性(r=-0.021,P=0.927)。(3)所有病人CRT反应率达81.81%(18/22),超反应率达36.36%(8/22)。结论 CRT临床疗效显著;通过更为严格的适应证把握,可以提高CRT反应率;CRT术后,MR的改善与LVEDD的减小和LVEF的增加相关,与QRS波宽度的缩短无相关性。更多还原

【Abstract】 Objective To analyze the clinical efficacy of cardiac resynchronization therapy(CRT) in patients with chronic heart failure(CHF).Methods The data of 22 CHF patients,who were treated with CRT in Lu’an People’s Hospital from June 2013 to July 2017,were collected and analyzed before and in 3 months of CRT including heart function [NYHA cardiac function classification,6-minute walk distance,brain natriuretic peptide(BNP)],electrocardiogram [heart rate(HR),QRS duration],echocardiogram [left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left atrial diameter(LA),mitral regurgitation(MR),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF)] and the blood test indicators(Cr,K~+,Na~+).The preoperative baseline values and the follow-up values in postoperative 3 months were examined by paired t-test.The change trend of MR scores and its correlation with the LVEDD,LVEF,PASP,LA,6-minute walk distance,QRS duration before and after CRT were analyzed by Pearson correlation analysis.Results(1) The preoperative baseline values and the follow-up values after 3 months of CRT were examined by paired t-test,which indicated that there were significant differences in the heart function(NYHA cardiac function classification:t=7.172,P<0.001;6-minute walk distance:t=-22.448,P<0.001;BNP:t=3.819,P=0.001),QRS duration(t=11.890,P<0.001),and most of the indexes of echocardiography(LVEDD:t=8.219,P<0.001;LVESD:t=7.611,P<0.001;LA:t=4.780,P<0.001;MR:t=6.394,P<0.001;LVEF:t=-6.759,P<0.001).There were no significant differences in HR,PASP,Cr,K~+,and Na~+.(2) The Pearson correlation analysis results showed that there was moderate correlation between the improvement of MR and the decrease of LVEDD(r=0.496,P=0.019) and the increase of LVEF(r=-0.486,P=0.022);there was no significant correlation between the improvement of MR and the shortening of QRS duration(r=-0.021,P=0.927).(3) The CRT response rate of all the 22 patients was 81.81%(18/22),and super response rate was 36.36%(8/22).Conclusions The clinical efficacy of CRT was remarkable.Through obeying the guidelines of CRT more strictly,the CRT response rate can be improved.The improvement of MR after CRT was related to the decrease of LVEDD and the increase of LVEF,but not to the shortening of QRS duration.更多还原