CAJ | 학술논문

目的应用超声心动图观察心脏再同步治疗(CRT)后不同时期AV、VV间期优化对心力衰竭血流动力学的影响,探讨AV、VV间期优化在增强CRT临床疗效中的作用.方法扩张性心肌病心力衰竭患者32例接受CRT治疗,并于植入术后7 d,3、6个月在超声心动图指导下进行AV、VV间期优化,观察优化后不同时间起搏参数、血流动力学指标.结果 32例入选患者均一次成功植入三腔起搏器,术后1、3、6个月随访起搏阈值、感知、阻抗的改变差异无统计学意义(P>0.05).CRT植入术后7 d,87%(28/32)、90%(29/32)患者分别需要AV、VV间期优化,植入术后6个月仍有18%(6/32)、16%(5/32)患者分别再次需要AV、VV间期优化.植入术后7 d、3个月优化起搏与术后未优化相比,舒张期充盈时间(DFT)延长、Tei指数下降(P<0.05).植入术后6个月优化起搏与植入术后即刻相比DFT延长、主动脉瓣前向血流速度时间积分(VTI)增加、Tei指数下降、E/Em比值下降、左心室射血分数(LVEF)明显增加(P<0.05).结论 CRT植入术后AV、VV间期优化改善心力衰竭患者的血流动力学,可以带来良好的临床疗效.
목적 응용초성심동도관찰심장재동보치료(CRT)후불동시기AV、VV간기우화대심력쇠갈혈류동역학적영향,탐토AV、VV간기우화재증강CRT림상료효중적작용.방법 확장성심기병심력쇠갈환자32례접수CRT치료,병우식입술후7 d,3、6개월재초성심동도지도하진행AV、VV간기우화,관찰우화후불동시간기박삼수、혈류동역학지표.결과 32례입선환자균일차성공식입삼강기박기,술후1、3、6개월수방기박역치、감지、조항적개변차이무통계학의의(P>0.05).CRT식입술후7 d,87%(28/32)、90%(29/32)환자분별수요AV、VV간기우화,식입술후6개월잉유18%(6/32)、16%(5/32)환자분별재차수요AV、VV간기우화.식입술후7 d、3개월우화기박여술후미우화상비,서장기충영시간(DFT)연장、Tei지수하강(P<0.05).식입술후6개월우화기박여식입술후즉각상비DFT연장、주동맥판전향혈류속도시간적분(VTI)증가、Tei지수하강、E/Em비치하강、좌심실사혈분수(LVEF)명현증가(P<0.05).결론 CRT식입술후AV、VV간기우화개선심력쇠갈환자적혈류동역학,가이대래량호적림상료효.
Objective To assess the hemedynamic effects of cardiac resynchronization therapy(CRT) with atrio-ventricular (AV)、interventricular (VV) delay optimization by echocardingram and evaluate the im-provement of clinical therapy in patients with AV、VV delay optimization in CRT. Methods Thirty-two dilated cardiomyopathy patients with severe heart failure were treated with CRT. All patients were regularly performed AV、VV delay optimization on 7th day,3rd month and 6th month after CRT. During the follow-up, hemedynamics by echocardiogram and pacing parameters were studied. Results All patients were implanted pacemaker suc-cessfully. No significant changes were observed in threshhold, sense and impedence on the 1th month, the 3rd month and the 6th month optimization (P>0.05). Twenty-eight cases were optimized AV delay (87%) and 29 cases were optimized VV delay (90%) on the 7th day after CRT. Meanwhile,AV delay was reoptimized in 6 ca-ses (18%) and VV delay was reoptimized in 5 cases (16%) on the 6th month after CRT. Diastolic filling time (DFT) increased significantly and Tei index decreased significantly (P<0.05 respectively) compared with pre-optimization. DFT, aortic velocity time integral (VTI), Tei, E/Em and LVEF were significantly ameliorated (P<0.05) on the 6th month after AV、VV delay optimization. Conclusion AV、VV delay optimization after CRT can improve the hemodynamics and clinical effects in patients with refractory heart failure.