中文摘要：

目的初步探讨左心室四极导线在心脏再同步化治疗（cardiac resynchronization therapy,CRT）中的临床应用。方法选取北京医院心内科2014年1月至2015年9月连续收治的CRT新植入患者共40例,分为四极导线组（13例）和双极导线组（27例）。比较两组患者的手术时间、X线曝光时间、心功能改善及并发症发生情况等的差异。结果两组患者左心室导线置入时间、手术时间、X线曝光时间、左心室导线位置比较,差异均无统计学意义（均P〉0.05）。术后6个月,四极导线组左心室射血分数（LVEF）[（38.2±4.1）%比（33.3±5.0）%,P=0.026]、纽约心脏病协会（NYHA）心功能分级[（2.4±0.4）级比（2.8±0.6）级,P=0.037]、CRT有反应率[11例（84.6%）比18例（66.7%）,P=0.017]和心功能改善≥1级[10例（76.9%）比18例（66.7%）,P=0.019]均优于双极导线组。此外,对于QRS波时限的缩短[（141.7±14.0）ms比（154.4±15.3）ms,P=0.006],四极导线组优势更为显著;而对于左心室舒张末期内径改善的比较,两组间差异无统计学意义（P〉0.05）。四极导线组在围术期对于膈神经刺激和阈值的管理优于双极导线组。结论短期随访提示左心室四极导线在血流动力学改善、CRT有反应率和临床疗效方面均优于双极导线。

英文摘要：

Objective To investigate the clinical application of left ventricular quadripolar lead in the treatment of cardiac resynchronization therapy（ CRT）. Methods A total of 40 patients with CRT who were admitted into the department of Cardiology of Beijing Hospital from January 2014 to September 2015 were selected and divided into two groups： the quadripolar lead group（ n = 13） and the bipolar lead group（ n = 27）. The operation time X-ray exposure time improvement of cardiac function and rates of complications were compared between the two groups. Results There was no significant difference between the two groups in left ventricular lead placement time,operation time,X-ray exposure time and left ventricular lead position（ all P 〉 0. 05）. 6 months after surgery,the left ventricular ejection fraction of the quadripolar lead group, NYHA classification of heart function, CRT reaction rate and heart function improvement ≥1 class of the NYHA classification were better than the bipolar lead group（ all P 〈 0. 05）.QRS wave duration shortening was more obvious in quadripolar wire group（ P 〈 0. 01）. There was no significant difference between the two groups in the improvement of left ventricular end diastolic diameter（ P 〉 0. 05）. Better control and management of phrenic nerve stimulation and pacing threshold was achieved in the quadripolar lead group in the perioperative period. Conclusions This short-term follow-up study showed that the left ventricular quadripolar lead was better than the bipolar lead in the improvement of hemodynamics,CRT reaction rate and clinical efficacy.