發(fā)布時(shí)間：2018-05-21 16:59

  本文選題：心衰 + 心臟再同步治療　； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:經(jīng)過大量多中心、隨機(jī)、雙盲臨床試驗(yàn)證實(shí),心臟再同步治療能改善心衰患者臨床癥狀、提高射血分?jǐn)?shù)、保證生活質(zhì)量、降低心衰住院率及全因死亡率。近些年來,隨著操作人員技術(shù)的熟練、符合條件患者數(shù)目的增加以及指南的更新,接受心臟再同步治療的患者明顯增加。但在篩選的患者中仍有20%-30%對心臟再同步治療無反應(yīng),加上CRT花費(fèi)較大,這限制了CRT的臨床應(yīng)用,造成了醫(yī)療資源的浪費(fèi),也給患者造成了過多的經(jīng)濟(jì)負(fù)擔(dān)。本文旨在探討影響心臟再同步治療預(yù)后的相關(guān)因素,并明確可預(yù)測CRT反應(yīng)性的獨(dú)立相關(guān)因素。方法:回顧性分析了2009年1月1日-2015年12月31日在蘭州軍區(qū)蘭州總醫(yī)院成接受心臟再同步治療的患者。所有患者均滿足最佳藥物治療下NYHA分級(Ⅱ-Ⅳ級)、嚴(yán)重?fù)p害的左室收縮功能(LVEF35%)、延長的QRS時(shí)限120ms。以術(shù)后12個(gè)月時(shí)心臟彩超LVEF值對≥5%,且術(shù)后12月內(nèi)無因心衰住院及無全因死亡為有反應(yīng)。結(jié)果:研究共納入82例慢性心衰患者,CRT有反應(yīng)59例(71.95%),無反應(yīng)23例(28.05%)。統(tǒng)計(jì)了每例患者的基本特征、基礎(chǔ)疾病、有無房顫、基礎(chǔ)腎功能、紅細(xì)胞分布寬度等信息。所得統(tǒng)計(jì)結(jié)果通過logistic回歸分析,逐步回歸納入研究變量,通過Wald檢驗(yàn),0.05為檢驗(yàn)水準(zhǔn),共篩選出3個(gè)暴露因素納入logistic回歸模型,并解釋統(tǒng)計(jì)結(jié)果:CRT有反應(yīng)的保護(hù)因素為LBBB,危險(xiǎn)因素為慢性房顫、基礎(chǔ)腎功能減退。結(jié)論:LBBB、房顫、基礎(chǔ)腎功能為CRT反應(yīng)性的獨(dú)立相關(guān)因素;合并LBBB的患者對CRT的反應(yīng)性較好,而房顫、基礎(chǔ)腎功能障礙(GFR60ml·min-1·1.73m-2)會降低患者對CRT的反應(yīng)性。
[Abstract]:Objective: a large number of multicenter, randomized, double-blind clinical trials have proved that cardiac resynchronization therapy can improve clinical symptoms, improve ejection fraction, ensure quality of life, reduce hospitalization rate and all-cause mortality of heart failure patients. In recent years, the number of patients receiving cardiac resynchronization has increased significantly with skilled operators, increased number of eligible patients and updated guidelines. However, 20% to 30% of the selected patients still have no response to cardiac resynchronization therapy, and CRT costs a lot, which limits the clinical application of CRT, resulting in a waste of medical resources and too much economic burden for patients. The purpose of this study was to investigate the prognostic factors of cardiac resynchronization therapy and to determine the independent correlation factors for predicting CRT reactivity. Methods: the patients receiving cardiac resynchronization in Lanzhou General Hospital of Lanzhou military region from January 1, 2009 to December 31, 2015 were retrospectively analyzed. All the patients were satisfied with the NYHA grade (grade 鈪，

本文編號：1920021