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目的 探讨双心室再同步治疗充血性心力衰竭的疗效。方法 所选择患者均为心功能Ⅲ～Ⅳ级 ,左心室舒张末期内径 >60mm ,EF值 <3 5 % ,E、A峰融合 ,二尖瓣中等度以上返流 ,完全性左束支传导阻滞 ,QRS时限 >14 0ms。应用Insync 80 40三腔起搏器 ,起搏电极定位于右心耳、右心室心尖部、冠状静脉窦左侧支或侧后分支。术后以VAT方式起搏。结果 例 1随诊 6个月 ,例 2随诊 1个月 ,2例术后心功能均提高至Ⅱ级 ,EF值明显提高 (例 1,2 1%VS3 0 % ;例 2 ,2 7%VS 3 8% ) ,QRS波时限明显缩短 (例 1,2 0 0msVS 110ms ;例 2 ,180ms ;例 2 ,VS 13 0ms) ,术后经心脏超声优化A—V间期 ,90ms时E、A峰分离程度最大 ,二尖瓣返流明显减少。例 1,术后 6个月左心房及左心室舒张末期内径无明显缩小。例 2 ,术后 1个月左心房 ( 4 3mmVS 3 5mm)及左心室舒张末期内径 ( 92mmVS 85mm)缩小明显。结论 双心室再同步治疗充血性心力衰竭近期疗效满意 ,是值得深入研究的新方法。
Objective To investigate the efficacy of biventricular resynchronization in the treatment of congestive heart failure. The patients selected were all patients with grade Ⅲ ~ Ⅳ cardiac function, end diastolic diameter of left ventricle> 60mm, EF value <35%, E, A peak fusion, moderate to moderate mitral regurgitation, complete left bundle branch resistance Hysteresis, QRS duration> 14 0ms. Insync 80 40 three-chamber pacemaker was used. The pacemaker was positioned in the right atrial appendage, the apex of the right ventricle, the left or the posterior branch of the coronary sinus. Postoperative VAT pacing. RESULTS: After 1 month follow-up in case 1 and 1 month after follow-up in case 2, the cardiac function increased to grade Ⅱ in 2 cases, and the EF value increased significantly (cases 1, 2% VS 3 0%; cases 2, 27% VS 3 8%), the QRS wave duration was significantly shortened (eg, 1,2 0 0msVS 110ms; Example 2, 180ms; Example 2, VS 13 0ms), postoperative ultrasound optimized A-V interval, 90ms E, A The maximum peak separation, mitral regurgitation was significantly reduced. Example 1, 6 months after left atrial and left ventricular end-diastolic diameter no significant reduction. Example 2, left atrium (4 3mmVS 3 5mm) and left ventricular end-diastolic diameter (92mmVS 85mm) narrowed significantly 1 month after operation. Conclusions Biventricular resynchronization therapy of congestive heart failure with satisfactory results in the near future is worthy of further study.