中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (06): 474-478.doi: 10.3969/j.issn.1671-4091.2026.06.007

• 临床研究 • 上一篇    下一篇

心脏再同步化治疗在维持性血液透析合并晚期心力衰竭患者中的疗效观察

魏桂玲   雒 湲   庄 冰   叶 红   张博晴   何伟春   

  1. 210003 南京，南京医科大学第二附属医院1肾脏病中心 2心血管中心
  • 收稿日期:2025-09-11 修回日期:2026-01-14 出版日期:2026-06-12 发布日期:2026-06-12
  • 通讯作者: 何伟春 E-mail:heweichun@njmu.edu.cn

Efficacy of cardiac resynchronization therapy in patients with maintenance hemodialysis with advanced heart failure

WEI Gui-ling,LUO Yuan,ZHUANG Bing,YE Hong, ZHANG Bo-qing,HE Wei-chun   

  1. Kidney Disease Center, and  2Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
  • Received:2025-09-11 Revised:2026-01-14 Online:2026-06-12 Published:2026-06-12
  • Contact: 210003 南京,南京医科大学第二附属医院1肾脏病中心 E-mail:heweichun@njmu.edu.cn

摘要： 目的  观察心脏再同步化治疗(cardiac resynchronization therapy,CRT)在维持性血液透析(maintenance hemodialysis,MHD)合并晚期心力衰竭(heart failure，HF)患者中的疗效和安全性。 方法  采用前瞻性观察性研究方法，选择2021年1月—2022年6月南京医科大学第二附属医院收治的符合CRT适应证的MHD合并晚期HF患者。观察患者手术后心功能、心电图、超声心动图等变化，记录不良事件发生情况。 结果  共纳入4例患者，其中男性2例，女性2例，平均年龄(62.3±7.9)岁，透析龄76.2(27.3，179.0)月，平均随访时间(19.7±9.9)月。随访结果显示：与手术前相比，患者QRS波时限由(183.3±26.3)ms缩短至(150.0±13.0)ms，左心室舒张末期内径由(70.3±10.3)mm降至(64.0±11.1)mm，左心室收缩末期内径由(57.8±13.2)mm降至(48.8±15.7)mm，E/e′由(27.5±9.9)降至(20.6±6.5)，氨基末端脑利钠肽前体(N-terminal pro brain natriuretic Peptide，NT-proBNP)中位水平由167 459.5(59 645.8，231 789.0)ng/ml降至81 773.0(26 151.3，134 313.0)ng/ml；降幅分别为18.2%、9.0%、15.6%、25.1%和51.2%。左心室射血分数由(32.8±7.4)%提高至(42.3±15.3)%，增幅为30.0%。纽约心脏病学会NYHA心功能分级，2例患者改善至NYHAⅠ级，2例改善至NYHAⅡ级。4例患者手术前均无法完成6 min步行试验，其中3例在手术后1年平均步行距离达(328.3±138.2)m。1例患者手术后发生菌血症。 结论  CRT可能有助于改善MHD合并晚期HF患者的心功能，并具有一定改善生活质量的潜力，其在特定人群中的短期安全性尚可接受，但对患者远期预后的影响未来仍需大样本研究进一步验证。

关键词: 心脏再同步化, 维持性血液透析, 晚期心力衰竭

Abstract: Objective  To observe the efficacy and safety of cardiac resynchronization therapy (CRT)  in patients on maintenance hemodialysis (MHD) with advanced heart failure (HF).  Methods  A prospective observational study was conducted. Patients with MHD and advanced HF who met CRT indications and were admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2021 to June 2022 were enrolled. Changes in cardiac function, electrocardiographic parameters, and echocardiographic parameters were observed after CRT implantation, and adverse events were recorded.  Results  A total of 4 patients were included (2 males, 2 females), with a mean age of (62.3±7.9) years, median dialysis vintage of 76.2 (27.3, 179.0) months, and mean follow-up time of (19.7±9.9) months. Compared with preoperative values, the QRS duration shortened from (183.3±26.3) ms to (150.0±13.0) ms; left ventricular end-diastolic diameter decreased from (70.3±10.3) mm to (64.0±11.1) mm; left ventricular end-systolic diameter decreased from (57.8±13.2) mm to (48.8±15.7) mm; E/e‘ ratio decreased from (27.5±9.9) to (20.6±6.5); and median N-terminal pro brain natriuretic peptide (NT-proBNP) level decreased from 167,459.5 (59,645.8, 231,789.0) ng/ml to 81,773.0 (26,151.3, 134,313.0) ng/ml, representing reductions of 18.2%, 9.0%, 15.6%, 25.1%, and 51.2%, respectively. Left ventricular ejection fraction increased from (32.8±7.4)% to (42.3±15.3)%, an increase of 30.0%. According to the New York Heart Association (NYHA) functional classification, 2 patients improved to NYHA class I and 2 to class II. None of the 4 patients could complete the 6-minute walk test preoperatively; among them, 3 achieved an average walking distance of (328.3±138.2) m at 1 year post-surgery. One patient developed bacteremia after surgery.  Conclusion  CRT may help improve cardiac function in MHD patients with advanced HF and has potential to improve quality of life. Its short-term safety in this specific population is acceptable. However, the impact on long-term prognosis requires further validation with larger sample sizes.

Key words: Cardiac resynchronization, Maintenance hemodialysis, advanced heart failure

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