中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2014年
2期
141-145
,共5页
王冬梅%齐书英%于海波%丁超%王刚%李洁%汝磊生%韩雅玲%臧红云
王鼕梅%齊書英%于海波%丁超%王剛%李潔%汝磊生%韓雅玲%臧紅雲
왕동매%제서영%우해파%정초%왕강%리길%여뢰생%한아령%장홍운
心力衰竭%心脏再同步治疗%QRS时限
心力衰竭%心髒再同步治療%QRS時限
심력쇠갈%심장재동보치료%QRS시한
Heart failure%Cardiac resynchronization therapy%QRS duration
目的：通过分析植入心脏再同步治疗( CRT)术后QRS时限( QRSd)的变化,评估术后不同的QRSd对CRT长期预后的影响。方法2001年4月至2012年3月来自沈阳军区总医院及白求恩国际和平医院住院并植入CRT的心力衰竭患者164例,按术后QRSd变化分为3组：Ⅰ组：107例( QRSd术前>术后),Ⅱ组：30例( QRSd术前<术后),Ⅲ组：27例( QRSd术前=术后)。观察术后3组病死率及心功能指标变化。结果随访48个月,3组患者的病死率及死因差异无统计学意义( P>0．05)。Ⅰ组和Ⅲ组术后心功能及左心室射血分数(LVEF)较Ⅱ组明显改善(P<0．05~0．01),且左心室舒张末期内径( LVEDD)明显缩小( P<0．05~0．01)。Ⅱ组术后心功能及 LVEF也明显改善( P<0．05~0．01),但LVEDD无明显缩小(P>0．05)。术后QRSd较术前变宽或变窄与术前QRSd的基础值有关,术前QRSd<140 ms是术后QRSd变宽的影响因素。结论术后QRSd变化对预后影响不同,QRSd变窄患者不但临床心功能恢复的较好,而且还可有明显的左心室逆重构,更奠定了长期心功能改善的基础。术后QRSd变化与术前QRSd有明显关系,术前QRSd<140 ms时,术后QRSd变窄的几率小,因此,术前QRSd越宽,术后QRSd变窄的效果越好。
目的：通過分析植入心髒再同步治療( CRT)術後QRS時限( QRSd)的變化,評估術後不同的QRSd對CRT長期預後的影響。方法2001年4月至2012年3月來自瀋暘軍區總醫院及白求恩國際和平醫院住院併植入CRT的心力衰竭患者164例,按術後QRSd變化分為3組：Ⅰ組：107例( QRSd術前>術後),Ⅱ組：30例( QRSd術前<術後),Ⅲ組：27例( QRSd術前=術後)。觀察術後3組病死率及心功能指標變化。結果隨訪48箇月,3組患者的病死率及死因差異無統計學意義( P>0．05)。Ⅰ組和Ⅲ組術後心功能及左心室射血分數(LVEF)較Ⅱ組明顯改善(P<0．05~0．01),且左心室舒張末期內徑( LVEDD)明顯縮小( P<0．05~0．01)。Ⅱ組術後心功能及 LVEF也明顯改善( P<0．05~0．01),但LVEDD無明顯縮小(P>0．05)。術後QRSd較術前變寬或變窄與術前QRSd的基礎值有關,術前QRSd<140 ms是術後QRSd變寬的影響因素。結論術後QRSd變化對預後影響不同,QRSd變窄患者不但臨床心功能恢複的較好,而且還可有明顯的左心室逆重構,更奠定瞭長期心功能改善的基礎。術後QRSd變化與術前QRSd有明顯關繫,術前QRSd<140 ms時,術後QRSd變窄的幾率小,因此,術前QRSd越寬,術後QRSd變窄的效果越好。
목적：통과분석식입심장재동보치료( CRT)술후QRS시한( QRSd)적변화,평고술후불동적QRSd대CRT장기예후적영향。방법2001년4월지2012년3월래자침양군구총의원급백구은국제화평의원주원병식입CRT적심력쇠갈환자164례,안술후QRSd변화분위3조：Ⅰ조：107례( QRSd술전>술후),Ⅱ조：30례( QRSd술전<술후),Ⅲ조：27례( QRSd술전=술후)。관찰술후3조병사솔급심공능지표변화。결과수방48개월,3조환자적병사솔급사인차이무통계학의의( P>0．05)。Ⅰ조화Ⅲ조술후심공능급좌심실사혈분수(LVEF)교Ⅱ조명현개선(P<0．05~0．01),차좌심실서장말기내경( LVEDD)명현축소( P<0．05~0．01)。Ⅱ조술후심공능급 LVEF야명현개선( P<0．05~0．01),단LVEDD무명현축소(P>0．05)。술후QRSd교술전변관혹변착여술전QRSd적기출치유관,술전QRSd<140 ms시술후QRSd변관적영향인소。결론술후QRSd변화대예후영향불동,QRSd변착환자불단림상심공능회복적교호,이차환가유명현적좌심실역중구,경전정료장기심공능개선적기출。술후QRSd변화여술전QRSd유명현관계,술전QRSd<140 ms시,술후QRSd변착적궤솔소,인차,술전QRSd월관,술후QRSd변착적효과월호。
Objective To analyze the factors which affect the QRS duration ( QRSd) after cardiac re-synchronization therapy ( CRT) and evaluate the affection of postoperative different QRSd on CRT in patients with heart failure (HF). Methods One hundred sixty-four patients with HF [130 men; mean age (58. 02± 10. 48)years,NYHA class Ⅲ in 84 patients and Ⅳ in 80 patients,left ventricular ejection fraction(LVEF)≤0. 35] for implantation of CRT device were studied between April 2001 and March 2012. The patients were di-vided into 3 groups according to postoperative QRSd change:GroupⅠ:107 cases,preoperative QRSd(164. 11± 72. 62)ms>postoperative QRSd(125. 78±28. 99)ms,GroupⅡ:30 cases,preoperative QRSd(121. 97±17. 26) ms<postoperative QRSd (156. 38±14. 75)ms,Group Ⅲ:27 cases preoperative QRSd (136. 96±19. 18)ms=postoperative QRSd ( 136. 96 ± 19. 18 ) ms. Patients were followed up for 6-48 months. Results During 48 months follow-up, there were 28 ( 26. 17%) deaths in GroupsⅠ, 7 ( 23. 33%) deaths in Group Ⅱ, and 5 (18. 52%)deaths in Group Ⅲ. Comparing with GroupⅡ,The NYHA class and LVEF were improved signifi-cantly and LVEDD were decreased significantly in GroupⅠand GroupⅢ(P<0. 05 and P<0. 01). The NYHA class and LVEF were improved significantly, but LVEDD were not decreased significantly in GroupⅡ. Conclusion There was better outcome in postoperative QRSd narrowed or unchanged patients than that in QRSd widen patients. The QRSd changes after CRT were related with the durations of preoperative QRS. The preopera-tive QRSd<140 ms was the main factor which made QRSd widen. Heart function parameters were improved sig-nificantly in patients ( QRSd<140 ms) with left ventricular dyssynchrony,but no left ventricular reverse remod-eling was observed in those patients ( QRSd<140 ms) .
