心电图QRS波时限缩短对CRT术后反应性的预测价值试卷.doc

心电图QRS波时限缩短CRT术后反应性预测价值baopeng@ 【摘要】 目的心脏再同步化治疗术后QRS时限缩短值是否对CRT疗效有预测价值。方法 检索1998年6月2010年1月发表的有关术后QRS时限缩短值对CRT有效性预测性研究，对纳入研究中有关试验设计、研究对象特征、研究结果等内容独立进行摘录，采用Cochrane协作网RevMan5.0软件进行分析。结果共6项临床研究，涉及研究人数471人，按术后随访6个月后有无反应性分为对CRT有反应组及无反应组， CRT术后QRS时限缩短在有反应组及无反应组中差异有统计学意义。结论术后QRS时限缩短值CRT疗效的一个独立预测因素。 【关键词】心脏再同步化治疗；反应性；QRS时限Value of QRS shortening in predicting response to cardiac resynchronization therapy among patients with end-stage heart failure TANG Bao-peng CHAO Hui-juan, Department of heart center，First Affiliated Hospital of Xinjiang Medical University Urumqi 830054,China Corresponding author：TANG Bao-peng，Email：tangbaopeng@ 【Abstract】Objective To study the predictive value of QRS shortening (ΔQRSd) following cardiac resynchronization therapy (CRT) for response to CRT in patients with end-stage heart failure. Methods The clinical stud of the value of QRS shortening in predicting response to cardiac resynchronization therapy in patients with end-stage heart failure were searched in Medline, Pubmed, Embase from Jun 1998 to Oct 2010, and Cochrane Library (Issue 3, 2010). The methodological quality of these papers was evaluated and the meta-analysis was performed by RevMan5.0 software．Results Six studies including five English papers and one Chinese papers were enrolled and 471 patients met the selection criteria. Meta-analysis results showed that QRS shortening following CRT differed significantly between responders and non-responders, there was a statistical difference in ΔQRS. Conclusion QRS shortening was a predictor of long-term clinical improvement after CRT in patients with severe heart failure. Key words: Cardiac resynchronization therapy; response; QRS duration; 心脏再同步化治疗（CRT）顽固性心衰心衰经循证医学证实可提高心衰患者生活质量、再住院率降低死亡率[1]。然而，按照的选择，仍然有30％患者对CRT治疗无反应[]。临床上仍没有可靠的指标能够CRT治疗的反应。近年[3-5]显示，提示术后QRS时限的缩短能够预测CRT的疗效，是其一个独立预测因素，但也有一些研究持否定看法[]。本文旨植入术后QRS时限缩短值是否能够预测CRT治疗的反应性。1．资料与方法1.1 纳入研究对象1）充分抗心力衰竭药物治疗后，NYHA心功能仍在级；2）左心室射血分数（LVEF）≤035；3）QRS时限≥120ms1.1.2 有反应者定义[] 随访至少6个