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慢性心力衰竭是临床发病率很高的心血管疾病之一,目前应用植入型心律转复除颤器(ICD)预防猝死的发生,“金三角”醛固酮受体拮抗剂、β受体阻滞剂、ACEI/ARB等药物与心脏再同步化治疗起搏器(CRT)等器械联合应用均取得良好效果。但就现有研究表明ICD的应用并没有改善心脏功能或症状,而植入CRT治疗的患者选择比较严格,部分患者无法植入满意位置或植入后存在CRT无应答,并且CRT不能改善有正常或轻度延长QRS间期的、有中度收缩功能障碍的患者。针对此局限性,近年来出现许多新的器械治疗方式为器械治疗心衰带来新的曙光,如心肌收缩调制术、左心室隔离装置、肾脏去神经术及脊髓神经刺激疗法等。本文旨在归纳心力衰竭现有器械植入状况,及对其最新进展进行较为全面的阐述。
Chronic heart failure is one of the cardiovascular diseases with high clinical incidence. At present, the application of implantable cardioverter defibrillator (ICD) to prevent sudden death, “Golden Triangle” aldosterone receptor antagonist, beta receptor resistance Laxatives, ACEI / ARB and other drugs and cardiac resynchronization therapy pacemakers (CRT) and other devices have achieved good results. However, the existing studies show that the application of ICD does not improve cardiac function or symptoms, while CRT patients have a more rigorous choice of options. Some patients can not be implanted in satisfactory sites or there is no CRT response after implantation, and CRT can not improve with normal Or slightly prolonged QRS interval, with moderate systolic dysfunction in patients. In response to this limitation, in recent years, many new device treatments have brought new dawn to the treatment of heart failure, such as myocardial contraction and modulation, left ventricular isolation device, renal denervation and spinal nerve stimulation therapy. This article aims to summarize existing implants in heart failure, and a more comprehensive exposition of their recent advances.