李明哲 左铁成 李阳

    [摘要] 1例診断为心功能Ⅳ级 纽约心脏病协会(New York heart association，NYHA)分级、完全性左束支传导阻滞的女性患者，在强心、利尿、扩管、改善心室重构等药物治疗基础上，接受心脏再同步化治疗(CRT)。术后心电图QRS波群时限由165 ms缩短至130 ms。随访3年，心脏超声显示：左心房内径(Left atrial diameter，LAD)由47 mm缩小至31 mm，左室舒张末内径(Left ventricular end diastolic diameter，LVEDd)由66 mm缩小至43 mm，左室射血分数(Left ventricular ejection fraction，LVEF)由14%升高至66%。患者日常活动无心悸、气短。术后2周发现患者右侧背部皮肤大面积放射性损伤，经清除坏死皮肤，凡士林油纱布包扎，定期换药等治疗后，放射性皮肤损伤逐渐愈合。

    [关键词] 心功能Ⅳ级;心脏再同步化治疗;超反应;放射性皮肤损伤

    [中图分类号] R541.7? ? ? ? ? [文献标识码] B? ? ? ? ? [文章编号] 1673-9701(2020)34-0145-04

    [Abstract] A female patient， with complete left bundle branch block， diagnosed as New York Heart Association (NYHA) grade Ⅳ and was treated with cardiac resynchronization therapy(CRT) on the basis of cardiac strengthen， diuretic therapy， cardiovascular expanding and improvement of ventricular remodeling. The QRS complex duration of ECG was shortened from 165 ms to 130 ms after operation. It was shown by the follow-up for 3 years that left atrial diameter(LAD) was decreased from 47 mm to 31 mm ......