本文選題：室性早搏 + 左心室功能��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:室性早搏(Premature Ventricular Contractions,PVC)是臨床上較常見的心律失常。最初特發(fā)性室早被認(rèn)為是單純的"良性"表現(xiàn),死亡風(fēng)險(xiǎn)與一般人群無顯著差異,但是近年來許多研究發(fā)現(xiàn),無潛在器質(zhì)性心臟病的PVC患者隨著PVC的發(fā)生與發(fā)展,會(huì)發(fā)生心室的可逆性重構(gòu),并逐漸出現(xiàn)左室功能受損等變化,甚至發(fā)生室性早搏性心肌病。尋找PVC對心臟功能及結(jié)構(gòu)的影響因素,從而探尋室性早搏性心肌病發(fā)生機(jī)制,成為目前研究的熱點(diǎn)之一。目的:分析室性早搏(Premature Ventricular Contractions,PVC)患者的性別、年齡、PVC病史時(shí)間、PVC負(fù)荷、PVC頻率的小時(shí)變異系數(shù)及四分位變異系數(shù)、QRS波時(shí)限、起源部位、聯(lián)律間期、有無非持續(xù)性室速等因素對左心功能、結(jié)構(gòu)的影響,為臨床PVC的診療及預(yù)后提供參考。方法:回顧性分析2015年5月至2016年11月期間于大連醫(yī)科大學(xué)附屬第一醫(yī)院心律失�？谱≡�,并診斷為PVC的患者,排除其他非室性心律失常疾病及已被診斷為器質(zhì)性心臟病患者。篩選出符合條件的患者共197例,根據(jù)患者左室射血分?jǐn)?shù)(Left Ventricular Ejection Fraction,LVEF)有無下降及左室內(nèi)徑(Left Ventricular End-diastolic internal Diameter,LVED)有無增寬,分組對照各組間性別、年齡,PVC的QRS波時(shí)限、負(fù)荷、頻率變異系數(shù)等的差異,分析各因素對左心功能及結(jié)構(gòu)的影響。應(yīng)用統(tǒng)計(jì)軟件SPSS 21.0進(jìn)行數(shù)據(jù)分析。結(jié)果:(1)各組間基線資料如年齡、性別,PVC病史時(shí)間,PVC的聯(lián)律間期、有無逆P'、有無間位PVC,有無非持續(xù)性室速,E/A均無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。(2)與相對應(yīng)的正常組的PVC負(fù)荷比較,LVEF下降組(25.31±11.01%vs.13.70±8.39%,P0.001)及 LVED 升高組(24.86± 11.46%vs.15.35±9.64%,P0.001)均偏高。PVC 負(fù)荷升高時(shí),LVEF 降低(58.18±2.51%vs.56.27±3.00%,P0.001),LVED 升高(46.23±4.30%vs.48.12±4.96%,P=0.008)。(3)比較LVEF下降組、LVED升高組與相對應(yīng)正常組PVC的QRS波時(shí)限,發(fā)現(xiàn)前者QRS波時(shí)限較長。QRS波時(shí)限延長時(shí),LVEF降低(58.19±2.28 vs.56.70± 3.11,P=0.001)。(4)LVEF下降組與正常組相比,小時(shí)變異系數(shù)(25.8%(20.0%,30.1%)vs.60.7%(46.8%,89.2%),P0.001)及四分位變異系數(shù)(15.8%(10.6%,22.5%)vs.44.7%(31.8%,67.7%),P0.001)均偏低,LVED升高組與正常組相比,小時(shí)變異系數(shù)(28.0%(21.1%,53.9%)vs.53.2%(36.4%,83.4%),P0.001)及四分位變異系數(shù)(21.0%(11.3%,33.5%)vs.38.4%(23.3%,63.6%),P0.001)亦偏低。(5)分析PVC起源部位,可見右室流出道(Right Ventricular Outflow Tract,RVOT)起源最多,占60.9%。比較不同PVC起源部位間LVEF、LVED、E/E'、LAV,無統(tǒng)計(jì)學(xué)差異(P0.05)。(6)按有無非持續(xù)性室速進(jìn)行分組,對比兩組間LVEF、LVED、E/E'、LAV,無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:本研究發(fā)現(xiàn),PVC負(fù)荷增大,QRS波時(shí)限延長,小時(shí)變異系數(shù)及四分位變異系數(shù)偏低的PVC患者更易出現(xiàn)LVEF下降、LVED升高。提示PVC心電特點(diǎn)對心功能危險(xiǎn)分層,及盡早識(shí)別有可能出現(xiàn)心臟功能及結(jié)構(gòu)損害的患者有臨床意義。
[Abstract]:Background: premature Ventricular PVC is a common arrhythmia. At first, idiopathic ventricular premature was regarded as a simple "benign" manifestation, and the risk of death was not significantly different from that of the general population. However, in recent years, many studies have found that PVC patients without potential organic heart disease develop with the onset and development of PVC. The reversible remodeling of the ventricle may occur, and the left ventricular function will be impaired gradually, and even ventricular premature cardiomyopathy will occur. To find out the influence factors of PVC on cardiac function and structure, and to explore the mechanism of ventricular premature cardiomyopathy (VPCM), has become one of the hot research topics. Objective: to analyze the gender, age and age of premature Ventricular cases (PVCs) patients with ventricular premature beats (VPB), and to analyze the time of variation and quartile variation of PVC loading frequency, the time limit of QRS wave, the origin of PVCs, and the associated rhythm interval. The influence of nonpersistent ventricular tachycardia on left ventricular function and structure provides a reference for the diagnosis, treatment and prognosis of PVC. Methods: from May 2015 to November 2016, the patients who were hospitalized in Arrhythmia Department of the first affiliated Hospital of Dalian Medical University and diagnosed as PVC were excluded from other non-ventricular arrhythmia diseases and had been diagnosed as organic heart disease. A total of 197 eligible patients were selected. According to the decrease of left ventricular ejection fraction (left Ventricular Ejection fraction) and the enlargement of left ventricular diameter (left Ventricular End-diastolic internal internal LVED), there were sex, age, QRS wave duration and load in control group. The influence of various factors on left ventricular function and structure was analyzed. The statistical software SPSS 21. 0 was used to analyze the data. Results (1) baseline data such as age, sex, time of PVC disease history, There was no significant difference in PVC load between the normal group and the normal group (P = 25.31 鹵11.01%vs.13.70 鹵8.39 vs P 0.001) and the group with elevated LVED (24.86 鹵11.46%vs.15.35 鹵9.64 P 0.001). All of them were lower than those of the normal group (58.18 鹵2.51%vs.56.27 鹵3.00 鹵3.00 鹵P 0.001). (46.23 鹵4.30%vs.48.12 鹵4.96) the duration of QRS wave in LVEF decreased group was higher than that in normal group, and the duration of QRS wave in PVC group was higher than that in normal group. It was found that when the time limit of the former QRS wave was longer. QRS wave duration was prolonged, the LVEF decreased by 58.19 鹵2.28 vs.56.70 鹵3.11P0. 001n. P0.001. P0.001. In the group of falling LVEFs, compared with the normal group, the coefficient of variation per hour was 25.80.00 and 30.1vs.60.7m, which was lower than that in the normal group, and the coefficient of variation at the quaternion was 15.810.67.5vs.44.7. the level of LVED was lower in the group with higher LVED than that in the normal group, and there was no significant difference between the two groups. The coefficient of variation of 28.00.21. 1: 53.9v s.53.2) and the coefficient of variation of 21.0% 11.33.35% and 38.4m 23.33.63.63.6P0.001) the origin of PVC was found to be the most common, accounting for 60.9% of the right ventricular outflow tract (right Ventricular Outflow tracts) in the right ventricular outflow tract (RVO), accounting for 66. 9% of the total number of RVOTs in the right ventricular outflow tract, accounting for 66. 9% of the total number of RVOTs in the right ventricular outflow tract, accounting for 66. 9%, and 33. 5% respectively (P 0. 001) (P 0. 001). The results showed that the origin of RVOT was the highest in the right ventricular outflow tract. There was no statistical difference between the two groups according to whether there was nonpersistent ventricular tachycardia, and there was no statistical difference between the two groups (P 0.05). Conclusion: in this study, we found that PVC patients with higher LVEF load and longer QRS wave duration were more likely to have increased LVEF decrease and LVED in patients with lower coefficient of variation and quartile variation. The results suggest that the characteristics of PVC ECG have clinical significance for risk stratification of cardiac function and early identification of patients with possible cardiac function and structure damage.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.7
，

本文編號(hào)：1776157