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目的探讨内科用药联合心脏再同步化治疗(CRT)慢性心力衰竭合并持续性心房颤动患者的临床疗效。方法选取2010年4月—2014年2月昆山市中医院收治的慢性心力衰竭合并持续性心房颤动患者54例。所有患者均行内科药物治疗,待心室率得到控制后行CRT;如患者心室率得不到有效控制,则行房室结消融术后再行CRT。根据是否行房室结消融术,将纳入患者分为A(内科用药+CRT,n=27)、B(内科用药+房室结消融术+CRT,n=27)两组。比较两组患者术前和术后6个月的起搏比例、心功能分级、6 min步行距离、QRS波时限、左心室射血分数(LVEF)及左心室舒张末期内径(LVEDD)。结果 B组患者的起搏比例高于A组(P<0.05)。术前、术后6个月,两组患者心功能分级、6 min步行距离、QRS波时限、LVEF及LVEDD比较,差异均无统计学意义(P>0.05);术后6个月,两组患者心功能分级、QRS波时限、LVEDD均低于术前,6 min步行距离、LVEF均高于术前(P<0.05)。结论对于慢性心力衰竭合并持续性心房颤动的患者,首先采用内科药物治疗,待心室率得到控制后再行CRT,可以保证患者的治疗疗效和预后,且不增加患者的经济负担和出血风险,建议在临床上推广应用。
Objective To investigate the clinical efficacy of medical treatment combined with cardiac resynchronization therapy (CRT) in patients with chronic heart failure and persistent atrial fibrillation. METHODS: From April 2010 to February 2014, 54 patients with chronic heart failure and persistent atrial fibrillation admitted to Kunshan Hospital of Chinese Medicine were selected. All patients underwent medical treatment, to be controlled after the ventricular rate CRT; if the patient’s ventricular rate can not be effectively controlled, the line of atrioventricular node ablation after CRT. According to whether atrioventricular node ablation was performed, the patients were divided into two groups: A (internal medicine + CRT, n = 27), B (internal medicine + AVN plus CRT, n = 27). The pacing rate, heart function grading, walking distance 6 min, QRS wave duration, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups before and 6 months after operation. Results The pacing rate in group B was higher than that in group A (P <0.05). There was no significant difference in cardiac function grading, 6-minute walk distance, QRS wave duration, LVEF and LVEDD between preoperative and postoperative 6 months (P> 0.05) The heart function of patients, QRS wave duration, LVEDD were lower than preoperative, 6 min walking distance, LVEF were higher than preoperative (P <0.05). Conclusions In patients with chronic heart failure complicated with persistent atrial fibrillation, medical treatment should be used first. After the ventricular rate is controlled before CRT, the curative effect and prognosis of the patients can be guaranteed without increasing the patients’ financial burden and the risk of bleeding. Promote the clinical application.