【摘要】 目的　观察双腔起搏治疗扩张型心肌病 (DCM)缓慢性心律失常合并心力衰竭的临床效果。方法　 2 5例DCM缓慢性心律失常合并心力衰竭患者 ,植入双腔起搏器。起搏频率调至 6 0～ 70次 / min,A - V间期在窦房结功能异常者调至 170～ 2 0 0 m s、房室传导阻滞或合并窦房结功能异常者调至 12 0～ 15 0 ms。并继续给予药物治疗心力衰竭 ,对伴频发室性早搏、短阵室性心动过速、阵发性心房颤动患者给予抗心律失常药物治疗 ,随访观察 0 .5～ 8年。结果　 2 4例临床症状明显改善 ,1例改善不明显。1例窦性心动过缓伴阵发性心房颤动患者和 2例窦性心动过缓伴有室性早搏、短阵室性心动过速的患者术后未用抗心律失常药物治疗 ,心房颤动、短阵室性心动过速消失 ,频发室性早搏显著减少。心功能平均改善达 1.5级 (P<0 .0 5 ) ,6 m in步行距离由平均 30 9m增加至 4 17m (P<0 .0 5 )。心排血量 (CO)在初期明显增加 (P<0 .0 0 1) ,左心室射血分数 (L VEF)改善 (P<0 .0 1) ,心胸比率、左心室舒张末径(L VEDD)、左心室收缩末径 (L VESD)变化无显著性差异 (P>0 .0 5 ) ,3月、6月后心胸比率、L VEDD、L VESD逐渐减小 (P<0 .0 5 ) ,CO、L VEF仍得以改善 ,尤其是在 3月时 L VEF改善显著 (P<0 .0 0 1)。结论　双腔起搏器是治疗缓慢性?更多还原

【Abstract】 Objective To observe the clinical effect of dual-chamber pacemaker on dilated cadiomyopathy (DCM) patients with bradycardia and heart failure. Methods 25 CDM patients with bradycardia and heart failure were recived plantation of dual-chamber pacemaker. The pacemaker’s frequency was modulated to 60~70 times/minute, A-V period was modulated to 170~200ms in patients with abnormal sinus function, while 120~150ms in patients with atrioventricular block or abnormal sinus function. Meanwhile, drugs were used to treat heart failure and arrhythmia. Each case was followed up from half year to 8 years.Results The clinical syptoms of 24 patients significantly improved except one case. Average heart function was improved to 1.5 degree (P<0.05), six-minute-walk-distance was enhanced from 309 m to 417 m (P<0.05). Heart pouring volume was increased markedly at early phase (P<0.001) and LVEF had some improved. Heart-to-chest ration, LVEDD and LVESD were decreased graduantly after treatment of 3 and 6 months (P<0.05), but they had not changed significantly at early stage (P>0.05). Especially, LVEF was improved markedly after treatment of 3 months(P<0.001). Conclusion Dual-chamber pacemaker is an effective method in the freatment of bradycardia, which also is benificial to patients complicated with heart failure.更多还原