CAJ | 학술논문

目的：分析心脏再同步治疗(CRT)患者术后药物治疗情况及与 CRT 反应性的关系。方法行 CRT 的慢性心力衰竭患者35例,平均年龄(64.1±9.7)岁；所有患者术前及术后6个月均行常规超声心动图检查,并根据临床表现评估术前及术后6个月患者心功能分级。对患者 CRT 植入前后药物治疗情况,尤其是β受体阻滞剂及血管紧张素转化酶抑制剂(ACEI)的使用情况进行分析。根据 CRT 术后反应性分为有反应组及无反应组,对两组β受体阻滞剂及 ACEI 术前和术后使用情况进行比较,分析 CRT 反应性与药物剂量变化的关系。结果 CRT 临床有反应组28例,无反应组7例。有反应组术前和术后美托洛尔平均使用剂量分别为(25.0±11.0)mg/d 和(59.6±24.4)mg/d (P <0.01),而无反应组术前和术后美托洛尔平均使用剂量分别为(25.0±8.8)mg/d 和(27.5±22.4)mg/d(P >0.05)。CRT 治疗有反应组术前和术后培哚普利日平均使用剂量分别为(3.47±0.91)mg/d 和(4.74±1.52)mg/d (P <0.05),而无反应组术前和术后培哚普利日平均使用剂量分别为(3.60±0.89)mg/d 和(3.80±0.45)mg/d(P >0.05)。CRT 术后反应性与 CRT 治疗前后β受体阻滞剂剂量变化有较好的相关性(r =0.688,P <0.01),而与ACEI 剂量变化无明显相关性(r =0.355,P >0.05)。结论 CRT 反应性与术后优化药物治疗相关,其治疗效果是优化药物治疗及起搏器治疗的共同作用结果。
목적：분석심장재동보치료(CRT)환자술후약물치료정황급여 CRT 반응성적관계。방법행 CRT 적만성심력쇠갈환자35례,평균년령(64.1±9.7)세；소유환자술전급술후6개월균행상규초성심동도검사,병근거림상표현평고술전급술후6개월환자심공능분급。대환자 CRT 식입전후약물치료정황,우기시β수체조체제급혈관긴장소전화매억제제(ACEI)적사용정황진행분석。근거 CRT 술후반응성분위유반응조급무반응조,대량조β수체조체제급 ACEI 술전화술후사용정황진행비교,분석 CRT 반응성여약물제량변화적관계。결과 CRT 림상유반응조28례,무반응조7례。유반응조술전화술후미탁락이평균사용제량분별위(25.0±11.0)mg/d 화(59.6±24.4)mg/d (P <0.01),이무반응조술전화술후미탁락이평균사용제량분별위(25.0±8.8)mg/d 화(27.5±22.4)mg/d(P >0.05)。CRT 치료유반응조술전화술후배타보리일평균사용제량분별위(3.47±0.91)mg/d 화(4.74±1.52)mg/d (P <0.05),이무반응조술전화술후배타보리일평균사용제량분별위(3.60±0.89)mg/d 화(3.80±0.45)mg/d(P >0.05)。CRT 술후반응성여 CRT 치료전후β수체조체제제량변화유교호적상관성(r =0.688,P <0.01),이여ACEI 제량변화무명현상관성(r =0.355,P >0.05)。결론 CRT 반응성여술후우화약물치료상관,기치료효과시우화약물치료급기박기치료적공동작용결과。
Objective To investigate pharmacologic therapy in patients receiving cardiac resynchronization therapy (CRT)and relationship with CRT response.Methods A total of 35 patients consisting 25 males and 10 females,mean age 64.1 ± 9.7 (48-75 )years old,who underwent CRT implantation for chronic heart failure were enrolled in this study.All patients were evaluated with conventional echocardiography before and 6 months after implantation.Cardiac function class (New York Heart Association,NYHA)was also assessed according to clinical performance.Medications such as beta-blocker and angiotensin-converting enzyme inhibitor (ACEI)were analyzed before and after CRT implantation.Patients were divided into responder group and non-responder group according to response to CRT. Beta-blocker and ACEI before and after CRT implantation were compared, respectively. Relationship between doses change of beta-blocker or ACEI and response to CRT were analyzed.Results There were 28 responders and 7 non-responders. Patients of responder group received larger metoprolol succinate therapy postoperatively compared with preoperatively(average daily dose 59.6±24.4 mg/d vs 25.0±1 1.0 mg/d,P <0.01), while patients of non-responder group had no significantly change(average daily dose 25.0±8.8 mg/d vs 27.5 ±22.4 mg/d,P > 0.05 ).Patients of responder group received larger perindopril therapy postoperatively compared with preoperatively (average daily dose 4.74±1.52 mg/d vs 3.47±0.91 mg/d,P <0.05),while patients of nonresponder group had no significantly change (average daily dose 3.60 ± 0.89 mg/d vs 3.80 ± 0.45 mg/d,P > 0.05 ). Furthermore,change of beta-blocker therapy had a good correlation with CRT response (r =0.688,P <0.01),while change of ACEI therapy had a poor correlation with CRT response(r =0.355,P >0.05).Conclusion Response to cardiac resynchronization therapy correlated with optimal pharmacologic therapy postoperatively. Optimal pharmacologic therapy and CRT may work together to improve outcomes.