本文選題：心臟再同步治療 + 左室四極導(dǎo)線　； 參考：《臨床心血管病雜志》2017年06期

【摘要】：目的:本文旨在評價(jià)左室四極導(dǎo)線在心臟再同步治療(CRT)中的應(yīng)用價(jià)值。方法:回顧性分析2014-01-2015-12在浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院行CRT時(shí)植入美國圣猶達(dá)公司左室導(dǎo)線的患者46例,其中四極導(dǎo)線組22例,雙極導(dǎo)線組24例,比較兩組患者左室導(dǎo)線植入時(shí)間、植入部位、起搏向量選擇等,術(shù)后隨訪6~12個(gè)月,比較兩組術(shù)后膈神經(jīng)刺激(PNS)、導(dǎo)線脫位等并發(fā)癥發(fā)生率及CRT反應(yīng)性等臨床療效。結(jié)果:兩組患者的術(shù)前左室舒張末期內(nèi)徑(LVEDd)、左室射血分?jǐn)?shù)(LVEF)和伴隨疾病等差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。四極組左室導(dǎo)線植入時(shí)間短于雙極組,但差異無統(tǒng)計(jì)學(xué)意義[(60.0±33.5)min:(66.2±33.9)min,P0.05];四極組100%避免了心尖部起搏,雙極組仍有4例(16.7%)左室導(dǎo)線起搏于心尖段(P0.05);術(shù)中四極組8例出現(xiàn)PNS,雙極組出現(xiàn)5例,四極組僅1例更換靶血管,7例均通過調(diào)整起搏向量解決(P0.01),而雙極組均更換靶血管。術(shù)后隨訪(13.4±4.1)個(gè)月,兩組患者NYHA、LVEF均較術(shù)前顯著改善(P0.05);與雙極組相比,四極組術(shù)后6個(gè)月LVEF(42.1±6.6)%:(35.1±8.7)%,P0.05]、CRT反應(yīng)性(81.8%:54.2%,P0.05)改善更顯著。術(shù)后四極組4例出現(xiàn)PNS,均通過調(diào)整起搏向量解決,雙極組2例出現(xiàn)PNS,通過降低輸出和增加脈寬后解決。四極組1例術(shù)后1個(gè)月左室導(dǎo)線脫位。結(jié)論:左室四極導(dǎo)線在避免心尖部起搏、減少PNS、縮短CRT植入時(shí)間上具有明顯優(yōu)勢,短期提高CRT反應(yīng)性高于雙極導(dǎo)線。
[Abstract]:Objective: to evaluate the value of left ventricular quadrupole traverse in cardiac resynchronization therapy (CRT). Methods: a retrospective analysis was made on 46 patients with left ventricular traverse implanted in the second affiliated Hospital of Zhejiang University School of Medicine from 2014-01-2015-12, including 22 cases in quadrupole traverse group and 24 cases in bipolar traverse group. The implantation time, site and pacing vector selection of left ventricular conductors were compared between the two groups. The postoperative follow-up was 6 ~ 12 months. The incidence of complications such as phrenic nerve stimulation, wire dislocation and CRT reactivity were compared between the two groups. Results: there was no significant difference in left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and associated diseases between the two groups (P 0.05). The left ventricular lead implantation time in the quadrupole group was shorter than that in the bipolar group, but the difference was not statistically significant [60.0 鹵33.5)min:(66.2 鹵33.9 min P 0.05]; 100% of the quadrupole group avoided the apical pacing, 4 cases of the bipolar group were still in the bipolar group) the left ventricular lead pacing occurred in the apical segment of the heart P0.05; in the quadrupole group, PNS was found in 8 cases, and in the bipolar group in 5 cases. In the quadrupole group, only one target vessel was replaced by adjusting the pacing vector in 7 cases, while the target vessel was replaced in the bipolar group. During the follow-up period of 13.4 鹵4.1 months, the LVEF of NYHAN in both groups was significantly improved than that in the preoperative group (P 0.05), and in the quadrupole group the LVEF(42.1 鹵6. 6%: 35. 1 鹵8. 7% was significantly improved 6 months after operation compared with that in the bipolar group (P 0. 05), and the response to CRT was significantly improved in the quadrupole group (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P 0. 05, P 0. 05, P < 0. 05). PNSs were found in 4 cases in the quadrupole group and in 2 cases in the bipolar group by adjusting the pacing vector, which were solved by decreasing the output and increasing the pulse width. One case in the quadrupole group had dislocation of left ventricular lead 1 month after operation. Conclusion: left ventricular quadrupole leads have obvious advantages in avoiding apical pacing, reducing PNS and shortening the time of CRT implantation. The short-term improvement of CRT reactivity is higher than that of bipolar conductors.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院心內(nèi)科;武警浙江省總隊(duì)醫(yī)院心內(nèi)科;浙江綠城心血管病醫(yī)院心內(nèi)科;浙江省中醫(yī)院心內(nèi)科;浙江醫(yī)院心內(nèi)科;浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院心內(nèi)科;
【分類號】：R541.6

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