CAJ | 학술논문

目的探讨多点组合再同步心脏起搏治疗伴有心室传导阻滞的难治性心力衰竭的临床效果.方法以河南省胸科医院收治的60例经药物治疗无效的难治性心力衰竭患者为研究对象,完全随机分为对照组和观察组,各30例对照组采用常规的抗心力衰竭药物治疗,观察组在抗心力衰竭药物的基础上,依据患者病情,分别植入右心房、有心室和冠状静脉左心室分支电极导线,以行房室顺序双心室同步起搏.分别记录治疗前后QRS时限、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、纽约心脏病协会(NYHA)心功能分级和6 min步行试验情况.结果观察组患者治疗前QRS时限为(187±13)ms,对照组为(188±15)ms;观察组患者的NYHA分级为(3.7±0.5),对照组为(3.7±0.5),2组NYHA分级比较差异无统计学意义(P＞0.05) 经过治疗,观察组患者的QRS时限为(131 ±11)ms,明显优于对照组的(180±12)ms,差异有统计学意义(P＜0.05),而观察组的NYHA分级在治疗后为(2.3±0.5),对照组为(3.0±0.5),差异有统计学意义(P＜0.05),观察组患者治疗后的LVEDD、LVEF、6 min步行距离分别为(64 ±6) mm、(34±7)％、(398±147)m,明显优于对照组的(73 ±8) mm、(25±8)％、(256±136)m,差异均有统计学意义(均P＜0.05).结论采用多点组合再同步心脏起搏的方法治疗伴有心室传导阻滞的难治性心力衰竭,临床效果明显优于药物治疗,患者心功能明显好转,心脏射血分数增加.
목적 탐토다점조합재동보심장기박치료반유심실전도조체적난치성심력쇠갈적림상효과.방법 이하남성흉과의원수치적60례경약물치료무효적난치성심력쇠갈환자위연구대상,완전수궤분위대조조화관찰조,각30례대조조채용상규적항심력쇠갈약물치료,관찰조재항심력쇠갈약물적기출상,의거환자병정,분별식입우심방、유심실화관상정맥좌심실분지전겁도선,이행방실순서쌍심실동보기박.분별기록치료전후QRS시한、좌심실서장말내경(LVEDD)、좌심실사혈분수(LVEF)、뉴약심장병협회(NYHA)심공능분급화6 min보행시험정황.결과 관찰조환자치료전QRS시한위(187±13)ms,대조조위(188±15)ms;관찰조환자적NYHA분급위(3.7±0.5),대조조위(3.7±0.5),2조NYHA분급비교차이무통계학의의(P＞0.05) 경과치료,관찰조환자적QRS시한위(131 ±11)ms,명현우우대조조적(180±12)ms,차이유통계학의의(P＜0.05),이관찰조적NYHA분급재치료후위(2.3±0.5),대조조위(3.0±0.5),차이유통계학의의(P＜0.05),관찰조환자치료후적LVEDD、LVEF、6 min보행거리분별위(64 ±6) mm、(34±7)％、(398±147)m,명현우우대조조적(73 ±8) mm、(25±8)％、(256±136)m,차이균유통계학의의(균P＜0.05).결론 채용다점조합재동보심장기박적방법치료반유심실전도조체적난치성심력쇠갈,림상효과명현우우약물치료,환자심공능명현호전,심장사혈분수증가.
Objective To observe and analyze the clinical effects of treating refractory heart failure associated with ventricular conduction block with multi point combination of cardiac resynchronization therapy.Methods Sixty cases with refractory heart failure after drug treatment in our hospital were chosen as study objects and were randomly divided into two groups according to the calculator method:the control group(30 cases) and the observation group(30 cases).The control group was given only conventional drug therapy for heart failure,the observation group was implanted into the right atrium,right ventricle and left ventricular coronary vein branch electrode wire,the atrioventricular sequential biventricular pacing on the basic of the heart failure drugs according to the illness.Before and after treatment,left ventricular ejection fraction (LVEF),New York heart association (NYHA) cardiac functional grading and 6 min were walking were noted.Results The QRS time limits before treatment of observation group patients was (187 ± 13)ms,while of the control group patients was (188 ± 15)ms,the NYHA grading of observation group was(3.7 ±0.5),which was the same as control group,the differences had no statistical significance(P ＞ 0.05).After treatment,the QRS time limits of observation group [(180 ± 12)ms] was significantly better than control group [(131 ± 11) ms],the differences were statistically significant (P ＜ 0.05),and the NYHA grading of observation group was (2.3 ± 0.5) while the control group was (3.0 ± 0.5),with statistical significance(P ＜ 0.05),the LVEDD,LVEF and walking distance in 6 min of observation group were (64 ± 6) mm,(34 ± 7)％,(398± 147)m respectively,which was much better than the control group of (73 ± 8)mm,(25±8)％,(256±136)m,the differences were statistically significant(P＜0.05).Conclusion The multipoint combination of cardiac resynchronization therapy on refractory heart failure associated with ventricular conduction block has better clinical effect than the drug treatment group by improving heart function of the patients and increase cardiac ejection fraction.