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为了解双心室再同步治疗(CRT)病人术前血清肌酐(SCr)水平对预后的影响,将99例病人根据术前SCr定量分为3组:I组,25例(SCr≤1.0 mg/dl);II组,54例(SCr 1.1~1.5 mg/dl);III组,20例(SCr>1.5 mg/dl)。SCr>2.5 mg/dl为排除病例。评估NYHA心功能、6 min步行距离(6-MWT)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及病死率(包括心源性死亡及非心源性死亡)。结果:①病死率:I组6例(24%),无因心衰恶化死亡;II组10例(18.5%),心衰恶化1例;III组7例(35%),心衰恶化3例。②心功能:各组术后3~6个月心功能均较术前明显改善(P<0.01),NYHA分级降低1级以上。③6-MWT:I组和II组术后3~6个月较术前明显增加(P<0.01),III组术后6个月较术前增加不明显(P>0.05)。④LVEDD:I组术后3~6个月较术前明显减小(P<0.05~0.01),II组和III组无明显减小(P>0.05)。⑤LVEF:I组和II组术后较术前明显增加(P<0.01),III组较术前亦明显增加(P<0.05),组间比较有明显差异(P<0.05)。结论:术前SCr水平影响病人对CRT的反应,短期随访发现SCr增高者对CRT反应差,病死率高,6-MWT、心脏超声指标的改善不如SCr正常组,可能是CRT无应答的原因之一。
To understand the effect of preoperative serum creatinine (SCr) level on prognosis in patients with biventricular resynchronization therapy (CRT), 99 patients were divided into three groups according to the preoperative SCr: group I, 25 patients (SCr≤1.0 mg / dl ); Group II, 54 (SCr 1.1-1.5 mg / dl); Group III, 20 (SCr> 1.5 mg / dl). SCr> 2.5 mg / dl for the exclusion of cases. NYHA cardiac function, 6-minute walking distance (6-MWT), left ventricular end diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) and mortality (including cardiac death and non-cardiac death) were assessed. Results: ① Case fatality rate: 6 cases (24%) in group I died of worsening of heart failure, 10 cases (18.5%) in group II, 1 case of worsening heart failure, 7 cases (35%) in group III, 3 example. Cardiac function: The cardiac function of 3 ~ 6 months postoperatively in each group was significantly improved compared with that before operation (P <0.01), and the NYHA classification was reduced by more than 1 grade. (3) The 6-MWT group I and II increased significantly from 3 to 6 months after operation (P <0.01), while the increase of 6-month MWT in group III was not significant (P> 0.05). (4) LVEDD: The I and IV groups were significantly reduced from 3 to 6 months after operation (P <0.05 ~ 0.01), but not from II and III groups (P> 0.05). (5) LVEF: The I and II groups were significantly higher than those before the operation (P <0.01), and the III group was significantly higher than that before the operation (P <0.05). There was significant difference between the two groups (P <0.05). CONCLUSIONS: The preoperative SCr level affects the response of patients to CRT. Short-term follow-up found that patients with elevated SCr have poor response to CRT, high mortality, 6-MWT, and cardiac echocardiographic improvement than those of normal SCr, which may be the reason of nonresponse to CRT one.