本文選題：心房顫動(dòng)　切入點(diǎn)：導(dǎo)管消融術(shù)　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察壓力監(jiān)測(cè)導(dǎo)管在心房顫動(dòng)導(dǎo)管消融術(shù)中的應(yīng)用效果方法:研究對(duì)象為2015年5月~2016年5月期間皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院心血管內(nèi)科收治的59例行導(dǎo)管消融術(shù)的心房顫動(dòng)(atrial fibrillation,AF)患者,使用隨機(jī)數(shù)字法將納入患者分為兩組。使用壓力監(jiān)測(cè)導(dǎo)管(SmartTouch,ST)消融的作為ST消融組,共32例,其中陣發(fā)性房顫29例,持續(xù)性房顫3例;使用普通鹽水灌注導(dǎo)管消融的作為常規(guī)消融組,共27例,其中陣發(fā)性房顫25例,持續(xù)性房顫2例。導(dǎo)管消融術(shù)后隨訪6~12個(gè)月,將ST消融組患者的手術(shù)時(shí)間、消融放電時(shí)間、X線曝光時(shí)間、X線曝光量、肺靜脈單圈隔離率、消融補(bǔ)點(diǎn)個(gè)數(shù)、并發(fā)癥的發(fā)生率及隨訪期間的復(fù)發(fā)率與常規(guī)消融組之間進(jìn)行比較。結(jié)果:常規(guī)消融組與ST消融組在性別、年齡、體重指數(shù)、房顫病程、房顫類型、合并癥、左房舒張末期內(nèi)徑(LAEDD)、左室射血分?jǐn)?shù)(LVEF)方面,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);ST消融組患者的手術(shù)時(shí)間、消融放電時(shí)間、X線曝光時(shí)間以及X線曝光量,均低于常規(guī)消融組,差異有統(tǒng)計(jì)學(xué)意義(128.0±23.4VS168.4±24.0;51.3±12.1VS80.6±19.8;14.2±3.6VS23.5±5.9;230.1±51.0VS315.0±69.0,P0.05);ST消融組患者的左肺靜脈單圈隔離率、右肺靜脈單圈隔離率高于常規(guī)消融組;左肺靜脈補(bǔ)點(diǎn)個(gè)數(shù)以及右肺靜脈補(bǔ)點(diǎn)個(gè)數(shù)低于常規(guī)消融組,差異有統(tǒng)計(jì)學(xué)意義(80.0%VS55.6%;85.0%VS59.3%;1.3±0.6VS2.8±1.5;0.8±0.4VS1.5±0.7,P0.05);ST消融組在導(dǎo)管消融術(shù)后出現(xiàn)皮下血腫的患者共有2例;常規(guī)消融組共有7例患者在導(dǎo)管消融術(shù)中及術(shù)后出現(xiàn)手術(shù)并發(fā)癥,其中有4例患者并發(fā)皮下血腫,1例患者并發(fā)食道水腫,2例患者并發(fā)心包填塞,經(jīng)過(guò)內(nèi)科積極保守治療后均治愈出院。采用Fisher確切概率法檢驗(yàn)得出ST消融組患者的手術(shù)相關(guān)并發(fā)癥的發(fā)生率低于常規(guī)消融組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(6.3%VS25.9%,P0.05)。在隨訪期內(nèi),發(fā)作持續(xù)時(shí)間≥30s的快速性房性心律失常的患者,在ST消融組共有3例,常規(guī)消融組共有8例,其中5位患者行二次導(dǎo)管消融手術(shù),3位患者予以抗心律失常藥物保守治療。將所得數(shù)據(jù)進(jìn)行卡方檢驗(yàn)得出,ST消融組患者導(dǎo)管消融術(shù)后的手術(shù)復(fù)發(fā)率低于常規(guī)消融組,差異有統(tǒng)計(jì)學(xué)意義(9.4%VS29.6%,P0.05)。結(jié)論:在房顫導(dǎo)管消融術(shù)中使用壓力監(jiān)測(cè)導(dǎo)管可以幫助術(shù)者更好的掌控導(dǎo)管與心肌組織之間的貼靠力度,提高肺靜脈單圈隔離成功率及減少消融補(bǔ)點(diǎn)個(gè)數(shù),從而有效的縮短手術(shù)時(shí)間、消融放電時(shí)間、X線曝光時(shí)間以及減少X線曝光量,也可以有效的降低房顫導(dǎo)管消融術(shù)后的復(fù)發(fā)率,因此具有較高的臨床應(yīng)用價(jià)值。
[Abstract]:Objective: to observe the effect of pressure monitoring catheter in atrial fibrillation catheter ablation. Methods: 59 cases of catheterization in the Department of Cardiovascular Medicine affiliated to the Southern Anhui Medical College from May 2015 to May 2016 were studied. Patients with atrial fibrillation after ablation, The patients were divided into two groups by random digital method. 32 patients were treated with pressure monitoring catheter SmartTouchus ST-ablation group, 29 patients with paroxysmal atrial fibrillation and 3 patients with persistent atrial fibrillation. A total of 27 patients, including 25 patients with paroxysmal atrial fibrillation and 2 patients with persistent atrial fibrillation, were treated with common brine perfusion catheter ablation. The patients were followed up for 6 to 12 months after catheter ablation, and the operative time of St ablation group was compared. The time of ablation discharge and the time of X-ray exposure, the isolation rate of pulmonary vein in single circle, the number of ablation points, Results: sex, age, body mass index, duration of atrial fibrillation, type of atrial fibrillation, complications were compared between conventional ablation group and St ablation group. There was no significant difference in left atrial end-diastolic diameter and left ventricular ejection fraction (LVEF) in patients with St ablation, such as operation time, ablation discharge time, X-ray exposure time and X-ray exposure, which were lower than those in the conventional ablation group, and there was no significant difference in left atrial end diastolic diameter and left ventricular ejection fraction (LVEF). The difference was statistically significant (128.0 鹵23.4VS168.4 鹵24.0VS81.3 鹵12.1VS80.6 鹵19.8VS23.5 鹵5.9230.1 鹵51.0VS315.0 鹵69.0VS315.0 鹵69.0VS0.05 + St ablation group), the isolation rate of right pulmonary vein was higher than that of conventional ablation group, the number of right pulmonary vein complement points and the number of left pulmonary vein complement points were lower than that of conventional ablation group. There were significant differences between the two patients with subcutaneous hematoma after catheter ablation in the St ablation group (1.3 鹵0.6VS2.8 鹵1.5VS2.8 鹵1.5VS0.8 鹵0.4VS1.5 鹵0.7VS0.05) and the routine ablation group (7 patients with postoperative complications during and after catheter ablation). Among them, 4 cases were complicated with subcutaneous hematoma, 1 case with oesophagus edema and 2 cases with pericardial tamponade. The incidence of surgical complications in St ablation group was lower than that in conventional ablation group, but the difference was not statistically significant (P 0.05). There were 3 cases in St ablation group and 8 cases in routine ablation group in patients with atrial tachyarrhythmia with duration 鈮，

本文編號(hào)：1642183