本文選題：房室傳導(dǎo)阻滯　切入點：心臟再同步化治療　出處：《南京醫(yī)科大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的：探索雙心室(BIV)起搏和右室心尖部(RVA)起搏對高度房室傳導(dǎo)阻滯(AVB)患者心臟結(jié)構(gòu)與功能的影響。方法：2009年5月至2012年12月間,采用隨機、雙盲、平行對照的方法在華東6家醫(yī)院的心內(nèi)科連續(xù)登記118例高度AVB患者行心臟再同步化治療(CRT),雙心室起搏一周后根據(jù)區(qū)組隨機化1：1程控分為BIV組(CRT-on)和RVA組(CRT-off),評價術(shù)后6和12個月患者因心力衰竭(HF)住院次數(shù)、心房顫動(AF)負荷、紐約心功能分級(NYHA)、6 min步行距離(6MWD)、明尼蘇達心力衰竭生活質(zhì)量評分(MLHF評分)、左心室射血分數(shù)(LVEF)、心室各腔容積和內(nèi)徑及N末端腦鈉肽原(NT-proBNP)等指標。結(jié)果：共納入114例成功植入CRT的患者。雙心室起搏1周時總體NYHAIⅢ級的比例[25.44%(29/114)VS 9.65%(11/114)]、MLHF評分(17.1±13.6 VS 26.9±21.6)、6MWD[(315.4±121.8)m VS (291.8±102.9)m]和NT-proBNP[157.0 (70.0,639.0) VS 444.7(144.0,1546.0)]較術(shù)前均改善(P均0.05)。隨機程控分為BIV和RVA組,每組57例,基線特征匹配。隨訪12個月兩組HF住院次數(shù)和AF負荷無差異；NYHA、6MWD和MLHF評分與術(shù)前相比有改善；與術(shù)后1周相比,NT-proBNP濃度BIV組無變化而RVA組有上升趨勢,6個月時兩組的變化值[3.3(-13.4,37.2)VS60(-18.1,248)]有差異(P=0.045)；各隨訪點LVEF, BIV組較術(shù)前有增加趨勢,6個月變化值(BIV3.18±6.79%VS RVA-1.41±6.44%,P0.05);與術(shù)后1周相比,左室舒張末期容積變化(△LVEDV, RV9.09±29.30ml VS BIV-16.68±24.30ml, P0.05)和內(nèi)徑變化(△LVEDD, RV2.36±9.32mm VS BIV-1.75±5.79mm,P0.05),BIV組縮小更明顯。結(jié)論：CRT起搏治療可早期改善高度AVB患者的心臟功能；隨訪12個月,雙心室起搏改善左室射血分數(shù)、縮小舒張末期左室心腔比右心室心尖部起搏更顯著。
[Abstract]:Objective: To explore the biventricular (BIV) pacing and right ventricular apex (RVA) pacing on high degree atrioventricular block (AVB) affect the structure and function of patients with heart. Methods: from May 2009 to December 2012, a randomized, double-blind, parallel control method of continuous registration in East China 6 Hospital Department of Cardiology 118 cases of high AVB patients with cardiac resynchronization therapy (CRT), biventricular pacing after a week according to the randomized controlled 1:1 were divided into BIV group (CRT-on) and RVA group (CRT-off), was evaluated after 6 and 12 months for patients with heart failure hospitalization (HF), atrial fibrillation (AF) load, the heart of New York function classification (NYHA), 6 min walking distance (6MWD), the quality of life of heart failure Minnesota score (MLHF score), left ventricular ejection fraction (LVEF), ventricular cavity volume and diameter and N terminal brain natriuretic peptide (NT-proBNP) and other indicators. Results: 114 cases of patients with CRT implantation were included double. 蹇冨璧鋒悘1鍛ㄦ椂鎬諱綋NYHAI鈪㈢駭鐨勬瘮渚媅25.44%(29/114)VS 9.65%(11/114)],MLHF璇勫垎(17.1鹵13.6 VS 26.9鹵21.6),6MWD[(315.4鹵121.8)m VS (291.8鹵102.9)m]鍜孨T-proBNP[157.0 (70.0,639.0) VS 444.7(144.0,1546.0)]杈冩湳鍓嶅潎鏀瑰杽(P鍧，

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