【摘要】 目的　观察双心室起搏在心力衰竭治疗中改善心功能和逆转左心室重塑的作用。方法2 0例充血性心力衰竭患者植入了双心室起搏器 ,其中男性 14例 ,女性 6例 ,平均年龄 (6 3± 13)岁 ,心功能NYHA分级III～IV级 ,射血分数 <4 0 % ,伴有QRS >14 0ms。在起搏器植入前、双心室起搏治疗 3个月后以及停止起搏 1个月后进行一系列评价。结果　起搏治疗 3个月后 ,左心室射血分数、心输出量及左心室充盈时间增加 ,二尖瓣反流、左心室舒张末期容积 [(196± 6 9)mlvs (15 9± 6 4 )ml,P <0 0 1]和收缩末期容积 [(15 5± 71)mlvs (117± 5 6 )ml,P <0 0 1]减少 ,患者 6min步行距离 [(332±89)mvs (372± 76 )m ,P <0 0 5 ]及生活质量提高。以上疗效为起搏依赖性 ,停止起搏 1个月后 ,各指标均有不同程度的下降。结论　对于心功能为NYHA分级III级或IV级伴有室内传导阻滞的心力衰竭患者 ,同步化双心室起搏治疗能逆转左心室重塑 ,改善心功能。更多还原

【Abstract】 Objective To investigate the role of biventricular pacing on reverse remodeling and improvement of cardiac function Methods Twenty patients [ mean age (63 ±13 )years, 14 males] with NYHA class III to IV heart failure, ejection fraction<40% and QRS duration>140ms were recruited for biventricular pacing therapy Serial assessment was performed before and up to 3 months after pacing, and repeated when pacing was withheld up to 4 weeks Results There was significant improvement of ejection fraction, cardiac output and left ventricular filling time; and decrease in mitral regurgitation, left ventricular end diastolic[ (196±69)ml vs (159±64)ml, P <0 01] and end systolic volumes [(155±71)ml vs (117±56)ml, P <0 01] after pacing for 3 months Six minute hall walk distance [(332±89)m vs (372±76)m , P <0 05] and quality of life score were also improved These benefits were pacing dependent as withholding the pacing resulted in varying speeds in the loss of cardiac functional and structural improvements Conclusions Synchronous biventricular pacing reverses left ventritricular remodeling and improves cardiac function in patients with NYHA class III to IV heart failure and electrocardiographic evidence of ventricular conduction delay更多还原