心力衰竭心脏再同步化治疗指南的沿革.pdfVIP

中华临床医师杂志( 电子版)2015 年5 月第9 卷第9 期 Chin J Clinicians(Electronic Edition),May 1,2015,Vol.9,No.9 ·1491 · ·专题笔谈· 心力衰竭心脏再同步化治疗指南的沿革 刘金秋 高连君 【摘要】 心力衰竭的心脏再同步化（CRT ）或心脏再同步化并植入心脏复律除颤器（CRTD ） 治疗是新兴的卓有疗效的介入治疗方法，但是疗效差别非常显著，有的患者出现超反应，心功能和 射血分数完全恢复正常，而有的患者则植入无效。由此派生出大量的临床试验，导致指南在不断更 新细化，直接影响我们的临床治疗决策。本文针对国内外CRT 指南的沿革和更新作一综述，明确最 新的适应证和患者选择，以提高CRT 在临床实践中的疗效。 【关键词】 心力衰竭； 心脏再同步化治疗 The innovation of the guidelines of cardiac resynchronization treatment for heart failure Liu Jinqiu, Gao Lianjun. Department of Cardiology, The Heart Center of the 1st Affiliated Hospital of Dalian Medical University, Dalian 116011, China Corresponding author: Gao Lianjun, Email: gaoljmd@126.com 【Abstract 】 Cardiac resynchronization and/or intracardiac defibrillator treatment (CRT and/or CRTD) is one of the developing and promising techniques for heart failure invasive treatments. The clinical outcomes of the CRT treatment are variable from super response to no response at all. The patients with super response is manifested as the heart function is improved tremendously from NYHA class Ⅲ or Ⅳ to NYHA class Ⅰand left ventricular function recover to normal range. Non-response means it is no use for some patients who are also candidates based on the indications of the recent guidelines. As a result, clinical trials focusing on the CRT become more and more, which leads to the innovation of the guidelines. The innovation and renewed contents in the guidelines are reviewed to demonstrate the new indications and clinical choices for CRT to improve the quality of heart failure care in clinic. 【Key words 】 Heart failure; Cardiac resynchronization treatment 心脏再同步化（CRT ）或心脏再同步化并植入 例患者无缓慢性心律失常，大多数患者 PR 间期较 心脏复律除颤器（CRTD ）治疗是近年来发展十分 长。7 例患者合并CLBBB ，心功能Ⅲ/Ⅳ级，AV 间 [1] 迅速的治疗心力衰竭的人工心脏起搏技术 ，随着 期设置100 ms 。5 年的随访中2 例因心功能持续恶 多项有关CRT/CRTD