【摘要】：目的:心臟再同步化治療(CRT)可使心臟收縮失同步心力衰竭(心衰)患者得到臨床獲益,即有反應(yīng),獲益明顯者心功能明顯改善即超反應(yīng)。然而,即使符合當(dāng)前指南推薦的患者,CRT植入后約三分之一的患者是“無反應(yīng)者”。因CRT價(jià)格昂貴,所以在醫(yī)療資源有限的前提下,如何在術(shù)前通過有效的預(yù)測指標(biāo)篩選出更可能出現(xiàn)超反應(yīng)的患者尤為重要。本研究通過對于天津市胸科醫(yī)院住院并接受CRT的心衰患者的一般特征、合并疾病、心電圖、超聲結(jié)果等各項(xiàng)相關(guān)指標(biāo)的基線、圍手術(shù)期和隨訪期間內(nèi)數(shù)據(jù)進(jìn)行回顧性分析,探討超反應(yīng)患者的可能預(yù)測因素。方法:入選自2013年3月至2015年1月于天津市胸科醫(yī)院住院并行CRT的心衰患者。所有患者均置入CRT,通過電子病歷系統(tǒng)或紙質(zhì)病例查詢所有患者基線及圍術(shù)期數(shù)據(jù),包括年齡、性別、心衰病程、心電圖(術(shù)前和術(shù)后即刻)、心臟超聲、藥物治療情況和伴隨疾病(包括擴(kuò)張性心肌病、缺血性心肌病、高血壓、糖尿病、心房顫動(dòng))。出院后3個(gè)月、6個(gè)月、12個(gè)月起搏器門診隨訪,此后,無癥狀患者每年隨訪一次。隨訪時(shí)評估患者近期NYHA分級,詢問有無心衰加重所致再入院等心源性事件,記錄心電圖、心臟超聲檢查和起搏器參數(shù)程控以及指導(dǎo)調(diào)整合理抗慢性心衰和抗心律失常藥物治療方案。超反應(yīng)定義為術(shù)后12個(gè)月隨訪過程中出現(xiàn)NYHA分級下降≥1級并且LVEF絕對值增加≥15%;心功能級別無降低或LVEF絕對值增加15%為非超反應(yīng)。結(jié)果:研究共入選心衰患者80例,年齡41-80(62.2±9)歲,其中男性59例(73.75%)。隨訪12個(gè)月期間,有26名(32.5%)患者對CRT出現(xiàn)超反應(yīng)。超反應(yīng)組的心衰病程顯著短于非超反應(yīng)組(34.85±42.03月vs.60.76±65.08月,P=0.036),女性比例顯著高于非超反應(yīng)組(42.0%vs.18.5%,P=0.024)。真LBBB的比例顯著高于非超反應(yīng)組(73.1.0%vs.44.4%,P=0.016)。因非缺血性心肌病所致心衰的比例顯著高于非超反應(yīng)組(88.5%vs.64.8%,P=0.027)�；�肺動(dòng)脈收縮壓(PASP)(36.08±10.04mmHg vs.42.72±10.22 mm Hg,P=0.008),左心房內(nèi)徑(LAD)(43.12±6.15 vs.46.50±7.16mm,P=0.042)和左室舒張末期內(nèi)徑(LVEDD)(70.12±9.36mm vs.75.24±10.18mm,P=0.034)同樣對CRT術(shù)后超反應(yīng)的發(fā)生具有預(yù)測價(jià)值。此外,超反應(yīng)組術(shù)后QRS波時(shí)限顯著短于非超反應(yīng)組(135.15±14.64ms vs.149.89±17.96ms,P0.001)。其他參數(shù)在兩組中比較差異無顯著統(tǒng)計(jì)學(xué)意義。此外,所有發(fā)生心源性事件不良預(yù)后的患者均來自非超反應(yīng)組。使用Kaplan-Meier生存曲線對所有患者不良心血管事件進(jìn)行分析,Log Rank方法比較結(jié)果顯示超反應(yīng)患者的心源性死亡事件和心衰再入院等心源性事件的發(fā)生率顯著低于非超反應(yīng)患者(P=0.001)。結(jié)論:女性、非缺血性心肌病、合并真LBBB、術(shù)后QRS波時(shí)限更短、基線PASP正常、左心房和左心室擴(kuò)張程度更小,心衰病程更短等因素可能與CRT置入術(shù)后超反應(yīng)的發(fā)生相關(guān)。
[Abstract]:Objective: cardiac resynchronization therapy (CRT) can benefit the patients with cardiac dyssynchrony heart failure (CHF). However, even in accordance with the current guidelines, about 1/3 of patients with CRT implantation are non-responders. Because of the high price of CRT, it is very important to screen out the patients who are more likely to overreact before operation under the premise of limited medical resources. This study analyzed retrospectively the general characteristics of patients with heart failure (HF) who were hospitalized and accepted CRT in Tianjin chest Hospital, the baseline of associated diseases, electrocardiogram and ultrasound results, and the data during perioperative period and follow-up period. To explore the possible predictive factors in patients with hyperactivity. Methods: from March 2013 to January 2015, patients with CRT were admitted to Tianjin chest Hospital. All patients were placed in CRT, to inquire about baseline and perioperative data of all patients, including age, sex, course of heart failure, electrocardiogram (pre-and post-operation), echocardiography, and so on. Drug therapy and associated diseases (including dilated cardiomyopathy, ischemic cardiomyopathy, hypertension, diabetes, atrial fibrillation). Pacemakers were followed up 3 months, 6 months and 12 months after discharge, and asymptomatic patients were followed up once a year. At the follow-up, the patients were evaluated for the recent NYHA grade, asked if there were cardiac events such as readmission due to the exacerbation of heart failure, and electrocardiogram was recorded. Echocardiography and program control of pacemaker parameters, as well as guiding the adjustment of rational anti-chronic heart failure and antiarrhythmic drug treatment. Superreaction was defined as the decrease of NYHA grade 鈮，

本文編號：2298017