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| 常规起搏器术后心力衰竭升级为心脏再同步化治疗的手术策略和操作技巧(附6例报告) |
| 朱玉峰1△,谭洪文1,2△,白元1,许旭东1,张志钢1,吴弘1,赵仙先1,秦永文1* |
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(1. 第二军医大学长海医院心内科, 上海 200433;
2. 贵州省人民医院心内科, 贵阳 550002
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨常规心脏起搏器术后心力衰竭升级为心脏再同步化治疗（CRT）的手术时机、策略和操作技巧。方法 收集2009年3月至2014年2月在第二军医大学长海医院心内科6例常规起搏器术后心力衰竭升级为心脏再同步治疗（CRT）患者的临床资料、手术方法及随访资料并进行回顾性分析。结果 6例患者中单腔起搏器(VVI)2例，双腔起搏器(DDD)4例。原起搏器囊袋位于左侧2例，左心室电极植入采用左锁骨下静脉途径，无需建立皮下隧道。原起搏器囊袋位于右侧4例，左心室电极植入采用右颈内静脉途径2例，走行于右颈内静脉至右胸前皮下隧道；采用左锁骨下静脉其中2例，走行于左胸至右胸皮下隧道。原电极导线一共10根，拔除2根，续用8根。所有患者均成功完成升级手术，无手术相关并发症。术后随访显示，与入院时相比，术后3天QRS波时限缩短（P＜0.05），BNP降低（P＜0.05），左室舒张末期内径、射血分数和NYHA心功能分级无明显变化；术后3月，QRS波时限缩短（P＜0.05），BNP降低（P＜0.05）,左室舒张末期内径缩小（P＜0.05），射血分数改善（P＜0.05），NYHA心功能分级平均提高一个等级。结论 术前制定正确手术策略，术中掌握手术操作技巧，是将常规心脏起搏器成功升级为CRT的关键。升级术后能显著提高左右心室收缩的同步性，改善心功能，提高生活质量。 |
| 关键词: 人工心脏起搏 心力衰竭 心脏再同步化治疗 器械升级 |
| DOI：10.3724/SP.J.1008.2015.00230 |
| 投稿时间：2014-04-24修订日期：2014-09-15 |
| 基金项目: |
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| Cardiac resynchronization therapy for patients with aggravated right ventricle-paced heart failure: a report of operation strategy and technique in 6 cases |
| ZHU Yu-feng1△,TAN Hong-wen1,2△,BAI Yuan1,XU Xu-dong1,ZHANG Zhi-gang1,WU Hong1,ZHAO Xian-xian1,QIN Yong-wen1* |
(1. Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Cardiovasology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, China
△Co-first author.
*
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| Abstract: |
| Objective To discuss the timing of surgery, operation strategy and technique of upgrading chronically right ventricle-paced heart failure patients to cardiac resynchronization therapy. Methods Six chronically right ventricle-paced heart failure patients underwent surgery of upgrading to CRT in our department between March 2009 to February 2014. The clinical characteristics, surgical techniques and follow-up data were retrospectively analyzed. Results Six patients, including single-chamber pacemaker (VVI) 2 cases, dual-chamber pacemaker (DDD) 4 cases, were successfully complete the upgrade operation, no complications. In two cases which original pacemaker pockets were on the left, the left ventricular electrodes were implanted through the left subclavian vein, without subcutaneous tunnel. In 4 cases which original pacemaker pockets were on the right, the left ventricular electrodes implanted through the right internal jugular vein in 2 patients, running in the subcutaneous tunnel from right internal jugular vein to the right chest, while in other 2 cases, the left ventricular electrodes implanted through Left subclavian vein, running in the subcutaneous tunnel from the right chest to the left chest. There were a total of 10 primary electrode wires, the two wires were removed, the eight were continued to use. Follow-up data showed that in the postoperative 3 days, compared with admission, CRT significantly reduced the mean ORS duration(P＜0.05)and BNP(P＜0.05),while left ventricular end-diastolic diameter, ejection fraction and NYHA class no significant changes. In the postoperative 3 months, CRT significantly reduced the mean ORS duration and BNP, and increased the LV ejection fraction, left ventricular end-diastolic diameter were reduced significantly, the patients cardiac function was improved by an average of one grade of NYHA functional class. Conclusion Correct preoperative operation strategy and intraoperative operation skills is the key of upgrading chronically right ventricle-paced to cardiac resynchronization therapy,Upgrade surgery can significantly improve the synchronization of left and right ventricular contraction, improve heart function and quality of life. |
| Key words: artificial cardiac pacing heart failure cardiac resynchronization therapy device upgrade |
