本文關(guān)鍵詞： 特發(fā)性室性心動(dòng)過速 器質(zhì)性心臟病室性心動(dòng)過速 心室復(fù)極 T波形態(tài)學(xué)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:室性心動(dòng)過速常發(fā)生于各種器質(zhì)性心臟病患者,但也可發(fā)生在無明確器質(zhì)性心臟病證據(jù)的中青年患者。特發(fā)性室性心動(dòng)過速(idiopathic Ventricular tachycardia,IVT簡稱特發(fā)性室速)指發(fā)生在心臟結(jié)構(gòu)正常的病人,目前的診斷技術(shù)未發(fā)現(xiàn)器質(zhì)性心臟病,也無電解質(zhì)異常和離子通道功能異常等。其發(fā)生率約占全部室速的10%,以青壯年居多。特發(fā)性室速由于無基礎(chǔ)心臟病變,多數(shù)血流動(dòng)力學(xué)穩(wěn)定,且射頻消融成功率高,通常預(yù)后良好。器質(zhì)性心臟病室性心動(dòng)過速(簡稱器質(zhì)性心臟病室速)由于基礎(chǔ)心臟病變的持續(xù)存在,室性心動(dòng)過速反復(fù)發(fā)作,且藥物和射頻消融治療效果欠佳,對于器質(zhì)性心臟病持續(xù)性室速和室撲/室顫,植入型心律轉(zhuǎn)復(fù)除顫器(ICD)治療是Ⅰ類適應(yīng)證。特發(fā)性室速的發(fā)生機(jī)制目前尚不明確,其能否像器質(zhì)性室速一樣引起心電圖的復(fù)極改變也研究較少。目的:本研究旨在分析健康人群和特發(fā)性室速患者、器質(zhì)性心臟病室速患者的心室復(fù)極參數(shù),首先,明確三組間心室復(fù)極參數(shù)及T波形態(tài)學(xué)參數(shù)是否存在差異;其次,探討心電圖心室復(fù)極各個(gè)參數(shù)對器質(zhì)性心臟病室速的預(yù)測價(jià)值;最后,明確針對室性心律失常危險(xiǎn)分層預(yù)測價(jià)值較好的復(fù)極參數(shù)。方法:選取大連醫(yī)科大學(xué)附屬第一醫(yī)院的特發(fā)性室速患者55例,器質(zhì)性心臟病室速患者41例,同時(shí)選取年齡、性別等因素同特發(fā)性室速組相匹配的健康對照組110例,采集所有患者竇性心律心電圖,對心電圖的心室復(fù)極參數(shù)QTc、TpTe、QTd、Tax(T波電軸)、立體QRS-T夾角及T波的形態(tài)學(xué)參數(shù)(PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、VMaxT_F、VMaxT_S、VMaxT_T、Ta_V5、Td_V5、bmTar_V5)進(jìn)行分析,比較三組患者參數(shù)的差異。結(jié)果:1.三組間心室復(fù)極各參數(shù)的比較:健康人群組和特發(fā)性室速組間QTc間期、立體QRS-T夾角、Tp-Te間期差異有統(tǒng)計(jì)學(xué)意義(P0.01,P=0.04,P=0.02),QTd、Tax無統(tǒng)計(jì)學(xué)差異(P=0.24,P=0.32)。健康人群組和器質(zhì)性心臟病室速組間QTc間期、立體QRS-T夾角、Tp-Te間期、QTd、Tax差異有統(tǒng)計(jì)學(xué)意義(P0.01,P0.01,P=0.01,P0.01,P0.01)。特發(fā)性和器質(zhì)性心臟病室速組間QTc間期、立體QRS-T夾角、Tax差異有統(tǒng)計(jì)學(xué)意義(P0.01,P0.01,P0.01),Tp-Te 間期、QTd 無統(tǒng)計(jì)學(xué)差異(P=0.59,P=0.10)。2.心室復(fù)極參數(shù)預(yù)測器質(zhì)性心臟病室速的ROC曲線,比較心電圖心室復(fù)極各個(gè)參數(shù)對器質(zhì)性心臟病室速的預(yù)測價(jià)值:立體QRS-T夾角曲線下面積為0.916,用于判斷器質(zhì)性心臟病室速有顯著意義(P0.01);QTc間期、Tax曲線下面積分別為0.736、0.752,用于判斷器質(zhì)性心臟病室速診斷價(jià)值尚可(P0.01,P0.01)。3.T波形態(tài)學(xué)參數(shù):健康人群組和特發(fā)性室速組間PCA、MCS-score、VAngT_S、VMaxT_F、VMaxT_T、ta_V5、bmTar_V5 差異有統(tǒng)計(jì)學(xué)意義(P0.01,P=0.04,P=0.02,P=0.02,P=0.03,P=0.01,P=0.01);VAngT_F、VAngT_T、VMaxT_S、td_V5無統(tǒng)計(jì)學(xué)差異(P=0.97,P=0.54,P=0.30,P=0.84)。健康人群組和器質(zhì)性心臟病室速組間 PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、VMaxT_F、ta_V5、td_V5、bmTar_V5 差異有統(tǒng)計(jì)學(xué)意義(P0.01,P0.01,P0.01,P=0.02,P0.01,P0.01,P0.01,P0.01,P0.01);VMaxT_S、VMaxT_T無統(tǒng)計(jì)學(xué)差異(P=0.87,P=0.23)。特發(fā)性室速組和器質(zhì)性心臟病室速組間PCA、MCS-score、VAngT_F、VAngT_S、VAngT_T、ta_V5、td_V5、bmTar_V5 差異有統(tǒng)計(jì)學(xué)意義(P0.01,P0.01,P0.01,P0.01,P0.01,P0.01,P0.01,P0.01);VMaxT_F、VMaxT_S、VMaxT_T 無統(tǒng)計(jì)學(xué)差異(P=0.06,P=0.33,P=0.47)。4.T波形態(tài)學(xué)參數(shù)預(yù)測器質(zhì)性心臟病室速R0C曲線,比較T波形態(tài)學(xué)參數(shù)對器質(zhì)性心臟病室速的預(yù)測價(jià)值:PCA、VAngT_S、VAngT_T、ta_V5、bmTar_V5、Tax 曲線下面積為 0.725、0.755、0.752、0.803、0.812、0.752,用于判斷器質(zhì)性心臟病室速診斷價(jià)值較好;MCS-score、VAngT_F、VMaxT_F、td__V5曲線下面積為0.629、0.634、0.656、0.615,用于判斷器質(zhì)性心臟病室速診斷價(jià)值尚可。結(jié)論:1.室速患者的心室復(fù)極參數(shù)不同于正常人,其中,器質(zhì)性心臟病室速的心室復(fù)極參數(shù)的變化最大,特發(fā)性室速次之。特發(fā)性室速一些心室復(fù)極參數(shù)較對照組發(fā)生改變,提示特發(fā)性室速患者可能存在室速發(fā)生的電生理基質(zhì)。2.特發(fā)性和器質(zhì)性心臟病室速心室復(fù)極參數(shù)存在差異,提示兩種室速基質(zhì)存在差異或電生理機(jī)制不同。3.立體QRS-T夾角、Tax及T波形態(tài)學(xué)部分參數(shù)三組間差異最大,是室性心律失常危險(xiǎn)分層較好的復(fù)極參數(shù)。
[Abstract]:Background: ventricular tachycardia occurs in all patients with organic heart disease, but also can occur in no clear evidence of organic heart disease in young patients with idiopathic ventricular tachycardia (idiopathic Ventricular tachycardia IVT, referred to as idiopathic ventricular tachycardia) occurs in normal heart structure the patient, diagnosis technique is found no organic heart disease, no abnormal electrolyte and ion channel dysfunction. Total 10% the incidence of ventricular tachycardia, mostly in young adults. Idiopathic ventricular tachycardia without underlying heart diseases, most hemodynamic stability, and high success rate of radiofrequency ablation usually, a good prognosis. Organic heart ventricular tachycardia (referred to as organic heart disease due to persistent heart disease rate) of ventricular tachycardia, recurrent, and drugs and the efficacy of radiofrequency ablation for poor organic heart disease Sustained ventricular tachycardia and ventricular fibrillation / flutter, implantable cardioverter defibrillator (ICD) therapy is a class I indications. Pathogenesis of idiopathic ventricular tachycardia is unclear, it can also study changes of ECG repolarization like organic ventricular tachycardia caused. Objective: This study aimed to analyze the healthy people and patients with idiopathic ventricular tachycardia, ventricular repolarization and ventricular tachycardia in patients with organic heart first, clear between the three groups of ventricular repolarization parameters and T wave morphology parameters whether there are differences; secondly, to investigate the electrocardiogram of ventricular repolarization parameters for the predictive value of organic heart disease rate; finally, according to the clear room arrhythmia risk stratification predict repolarization good value. Methods: the First Affiliated Hospital of Dalian Medical University of patients with idiopathic ventricular tachycardia in 55 cases, for patients with cardiac ventricular tachycardia in 41 cases, and select the age, gender and other factors with idiopathic Vt group matched healthy control group of 110 patients, collected all patients with sinus rhythm ECG, ventricular repolarization parameters QTc, QTd, TpTe on ECG, Tax (T wave axis), the morphological parameters of stereo QRS-T angle and T waves (PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, VMaxT_F, VMaxT_S VMaxT_T, Ta_V5, Td_V5, bmTar_V5), analyze, compare the difference between the three groups. Results: comparison of 1. parameters between the three groups of ventricular repolarization parameters: healthy group and idiopathic ventricular tachycardia group between QTc interval, stereo QRS-T angle, Tp-Te interval was statistically significant differences (P0.01, P=0.04, P=0.02) QTd, Tax, no statistical difference (P=0.24, P=0.32). The healthy group and organic heart disease rate between group QTc interval, Tp-Te interval, QRS-T stereo angle, QTd, there were significant differences in Tax (P0.01, P0.01, P=0.01, P0.01, P0.01). Idiopathic ventricular tachycardia and organic group QTc interval, QRS- stereo T angle, there were significant differences in Tax (P0.01, P0.01, P0.01), Tp-Te interval, QTd no significant difference (P=0.59, P=0.10) ROC curve.2. predictor of ventricular repolarization parameters cardiac ventricular tachycardia in the predictive value of ECG ventricular repolarization parameters on organic heart disease rate: area QRS-T stereo angle curve for the 0.916, used to determine the organic heart disease rate was significant (P0.01); QTc interval, area under the Tax curve were used to determine the 0.736,0.752, organic heart disease diagnosis speed (P0.01, P0.01) is.3.T wave morphology parameters: healthy group and idiopathic ventricular tachycardia group PCA. MCS-score, VAngT_S, VMaxT_F, VMaxT_T, ta_V5, bmTar_V5 difference was statistically significant (P0.01, P=0.04, P=0.02, P=0.02, P=0.03, P=0.01, P=0.01); VAngT_F, VAngT_T, VMaxT_S, no significant difference between td_V5 (P=0.97, P=0.54, P=0.30, P=0.84). The healthy group And organic heart disease rate between group PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, VMaxT_F, ta_V5, td_V5, bmTar_V5 difference was statistically significant (P0.01, P0.01, P0.01, P=0.02, P0.01, P0.01, P0.01, P0.01, VMaxT_S, P0.01); no significant difference between VMaxT_T (P=0.87, P=0.23) idiopathic. VT group and organic heart disease rate between group PCA, MCS-score, VAngT_F, VAngT_S, VAngT_T, ta_V5, td_V5, bmTar_V5 difference was statistically significant (P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, VMaxT_F, VMaxT_S, P0.01); no significant difference between VMaxT_T (P=0.06, P=0.33, P=0.47.4.T wave morphology parameters) predictor cardiac ventricular tachycardia in the R0C curve, the predictive value of T wave morphology parameters of organic heart disease rate: PCA, VAngT_S, VAngT_T, ta_V5, bmTar_V5, the area under the Tax curve was used to determine 0.725,0.755,0.752,0.803,0.812,0.752, organic heart disease diagnosis rate of price The value of MCS-score, VAngT_F, VMaxT_F is better; and the area under the td__V5 curve was used to determine 0.629,0.634,0.656,0.615, organic heart disease diagnosis can speed. Conclusion: the ventricular repolarization parameters of 1. patients with ventricular tachycardia is different from normal people, the changes of ventricular repolarization parameters of organic heart disease rate maximum, idiopathic ventricular the speed of idiopathic ventricular tachycardia. Some ventricular repolarization parameters compared with the control group changed, suggesting that idiopathic ventricular tachycardia patients may be the electrophysiological matrix.2. of idiopathic ventricular tachycardia and ventricular tachycardia in cardiac ventricular repolarization parameters are different, suggesting that the two ventricular tachycardia matrix differences or electrophysiological mechanism different.3. stereo QRS-T angle, the difference between the three groups of Tax and T wave morphology parameters is the maximum repolarization ventricular arrhythmia risk stratification is better.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.71
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本文編號(hào)：1540150