心脏移植的“桥梁”:血液吸收、心室重塑还是左心室舒张?摘要

K. Denysiuk, O. Loskutov, O. Druzhyna
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摘要

背景。心力衰竭(HF)是一个全球性的公共卫生问题[2]。严重心衰最常见的病因是扩张型心肌病(DCM)[6]。发病率和死亡率不断上升,表明该病种的治疗存在未解决的问题[3]。目的:探讨不同治疗方法对DCM所致重度心衰患者的疗效。材料和方法。回顾性分析了2005年至2021年期间86例DCM背景下的严重HF患者的治疗结果。所有患者根据治疗方式分为三组:第一组(n=59) -保守治疗的标准方案辅以一个疗程的血液吸收(HS);2.1组(n=21)行左心室重构手术;2.2组(n=6)植入左心室辅助装置(LVAD)。在研究中,我们分析了患者的临床状况、经胸超声心动图结果、并发症和死亡率:治疗前、住院治疗结束时和长期(12个月后)。统计学评价采用Student检验和Pearson χ2检验(显著性水平p<0.05)。治疗后,各组患者临床状况均改善1个NYHA级(p<0.05)。1组左室射血分数(LVEF)由21.1±4.66%增加到34±2.59%,2.1组由22.4±2.27%增加到35.65±5.25% (p<0.05)。我们还观察到左室逆重构,1组左室舒张末期容积(LV EDV)和收缩末期容积(LV ESV)分别降至242.16±26.11 ml和148.6±21.3 ml (p<0.05), 2组分别降至228.75±20.5 ml和141.5±17.5 ml (p<0.05)。2.2组上述指标分别降至261、2±103.56 ml(下降29.15%)和193±92.27 ml(下降36.23%),差异均有统计学意义(p<0.05)。在DCM背景下,体外治疗和手术治疗可以可靠地改善重症心衰患者的临床状况,并且可以在保守治疗方案的基础上使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
«BRIDGE» TO HEART TRANSPLANTATION: HEMOSORPTION, VENTRICULAR REMODELING OR LVAD? ABSTRACT
Background. Heart failure (HF) is a global public health problem worldwide [2]. The most frequent cause of severe HF is dilated cardiomyopathy (DCM) [6]. The morbidity and mortality rate are constantly growing, which indicates the presence of unresolved issues in the therapy of this nosology [3]. Aim. To determine the efficacy of alternative methods of treatment in patients with severe HF caused by DCM. Materials and methods. A retrospective analysis of the treatment results in 86 patients with severe HF on the background of DCM during the period from 2005 to 2021. All patients were divided into three groups depending on the type of treatment: in group 1 (n=59) – the standard protocol of conservative therapy was supplemented with a course of hemosorption (HS); in group 2.1 (n=21) – left ventricular remodeling surgery was performed; in group 2.2 (n=6) – left ventricular assist device (LVAD) was implanted. During the study we analyzed patients’ clinical condition, the results of transthoracic echocardiography, complications and mortality: before treatment, by the end of in-hospital treatment and in the long-term period (12 months later). Statistical evaluation was performed using Student’s test and Pearson’s χ2 test (significance level p<0.05). Results. After the therapy, all groups showed improvement of clinical condition of the patients by one NYHA class (p<0.05). There was an increase of left ventricular ejection fraction (LVEF) from 21.1±4.66 % to 34±2.59 % in group 1 and from 22.4±2.27 % to 35.65±5.25 % in group 2.1 (p<0.05). We also observed inverse LV remodeling with marked decrease of LV end-diastolic volume (LV EDV) and LV end-systolic volume (LV ESV) to 242.16±26.11 ml and 148.6±21.3 ml ( p<0.05) in group 1, to 228.75±20.5 ml and 141.5±17.5 ml (p<0.05) in group 2. 1 and a significant decrease in these indices in group 2.2 to 261, 2±103.56 ml (by 29.15%) and to 193±92.27 ml (by 36.23%) (p<0.05), respectively. Conclusion. Extracorporeal and surgical methods of treatment of patients with severe HF against DCM background reliably improve their clinical condition and can be used in addition to the protocol of conservative therapy.
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