摘要
目的分析慢性心力衰竭病人心脏再同步化治疗(CRT)的临床疗效。方法回顾性分析六安市人民医院2013年6月至2017年7月22例慢性心力衰竭病人CRT的临床资料:CRT术前及术后3个月心功能[NYHA心功能分级,6 min步行距离,脑钠肽(BNP)]、心电图(HR,QRS波宽度)、心脏超声[左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左房内径(LA),二尖瓣返流(MR),肺动脉收缩压(PASP),左室射血分数(LVEF)]及血检验指标(Cr,K^+,Na^+)的数据,对上述指标的术前基线值及术后3个月随访值行配对t检验。对病人CRT术前及术后3个月MR评分与LVEDD、LVEF、PASP、LA、6 min步行距离、QRS波宽度的变化趋势进行Pearson相关性分析。结果 (1)术前基线值及术后3个月随访值行配对t检验:治疗前后心功能指标差异有统计学意义(NYHA心功能分级,t=7.172,P<0.001;6 min步行距离,t=-22.448,P<0.001;BNP,t=3.819,P=0.001);治疗前后QRS波宽度差异有统计学意义(t=11.890,P<0.001);治疗前后大部分心脏超声指标差异有统计学意义(LVEDD,t=8.219,P<0.001;LVESD,t=7.611,P<0.001;LA,t=4.780,P<0.001;MR,t=6.394,P<0.001;LVEF,t=-6.759,P<0.001);两组HR、PASP、Cr、K^+、Na^+之间差异无统计学意义。(2)经Pearson相关性分析,CRT术后MR的改善与LVEDD的减小(r=0.496,P=0.019)和LVEF的增加(r=-0.486,P=0.022)呈中等程度相关;与QRS波宽度缩短之间无显著相关性(r=-0.021,P=0.927)。(3)所有病人CRT反应率达81.81%(18/22),超反应率达36.36%(8/22)。结论 CRT临床疗效显著;通过更为严格的适应证把握,可以提高CRT反应率;CRT术后,MR的改善与LVEDD的减小和LVEF的增加相关,与QRS波宽度的缩短无相关性。
Objective To analyze the clinical efficacy of cardiac resynchronization therapy(CRT)in patients with chronic heart failure(CHF).Methods The data of 22 CHF patients,who were treated with CRT in Lu an People s Hospital from June 2013 to July 2017,were collected and analyzed before and in 3 months of CRT including heart function[NYHA cardiac function classification,6-minute walk distance,brain natriuretic peptide(BNP)],electrocardiogram[heart rate(HR),QRS duration],echocardiogram[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left atrial diameter(LA),mitral regurgitation(MR),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF)]and the blood test indicators(Cr,K+,Na+).The preoperative baseline values and the follow-up values in postoperative 3 months were examined by paired t-test.The change trend of MR scores and its correlation with the LVEDD,LVEF,PASP,LA,6-minute walk distance,QRS duration before and after CRT were analyzed by Pearson correlation analysis.Results(1)The preoperative baseline values and the follow-up values after 3 months of CRT were examined by paired t-test,which indicated that there were significant differences in the heart function(NYHA cardiac function classification:t=7.172,P<0.001;6-minute walk distance:t=-22.448,P<0.001;BNP:t=3.819,P=0.001),QRS duration(t=11.890,P<0.001),and most of the indexes of echocardiography(LVEDD:t=8.219,P<0.001;LVESD:t=7.611,P<0.001;LA:t=4.780,P<0.001;MR:t=6.394,P<0.001;LVEF:t=-6.759,P<0.001).There were no significant differences in HR,PASP,Cr,K+,and Na+.(2)The Pearson correlation analysis results showed that there was moderate correlation between the improvement of MR and the decrease of LVEDD(r=0.496,P=0.019)and the increase of LVEF(r=-0.486,P=0.022);there was no significant correlation between the improvement of MR and the shortening of QRS duration(r=-0.021,P=0.927).(3)The CRT response rate of all the 22 patients was 81.81%(18/22),and super response rate was 36.36%(8/22).Conclusions The cl
作者
余世成
冯俊
孙召金
黄海涛
YU Shicheng;FENG Jun;SUN Zhaojin;HUANG Haitao(Department of Cardiology,Lu an People s Hospital / Lu an Affiliated Hospital of AnhuiMedical University,Lu an,Anhui 237000,China)
出处
《安徽医药》
CAS
2019年第4期717-721,共5页
Anhui Medical and Pharmaceutical Journal
关键词
心脏再同步化疗法
心力衰竭
心肌病
扩张型
二尖瓣闭锁不全
束支传导阻滞
每搏输出量
利钠肽
脑
Cardiac resynchronization therapy
Heart failure
Cardiomyopathy,dilated
Mitral valve insufficiency
Bundle-branch block
Stroke volume
Natriuretic peptide,brain
