發(fā)布時(shí)間：2018-04-23 05:16

  本文選題：零射線 + 右室流出道��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景室性早搏(premature ventricular contractionsPVCs)是一種異位搏動(dòng)介導(dǎo)的電活動(dòng),可來源于心房外的心臟其他組織結(jié)構(gòu)。在無結(jié)構(gòu)性心臟病的特發(fā)性PVCs中,PVCs來源主要來自右室流出道,而多數(shù)結(jié)構(gòu)性心臟病來源于左心室[1]。PVCs可發(fā)生于正常人,隨著年齡增長(zhǎng),發(fā)病率增高,45-65歲無結(jié)構(gòu)性心臟病人群中發(fā)生率達(dá)6%[2],正常人群中PVCsHolter檢出率1.3%-20%[3]。PVCs臨床表現(xiàn)變異性很大,最常見為心悸、心慌感,嚴(yán)重者可觸發(fā)惡性心律失常引起黑蒙、暈厥、猝死。近來研究發(fā)現(xiàn)頻發(fā)PVCs有潛在引起左心功能不全及擴(kuò)張性心肌病危險(xiǎn)[4-9],導(dǎo)管導(dǎo)管射頻消融術(shù)(Radio Frequency Catheter Ablation RFCA)能成功逆轉(zhuǎn)PVCs相關(guān)的心肌病。但傳統(tǒng)RFCA中的存在放射損傷,三維電解剖標(biāo)測(cè)系統(tǒng)指導(dǎo)下的RFCA能最大程度減少術(shù)中X線的暴露,且手術(shù)更加安全精準(zhǔn)高效,有的甚至能達(dá)到零射線下完成手術(shù)。目的通過與常規(guī)X線指導(dǎo)對(duì)比,評(píng)估Carto3三維電解剖標(biāo)測(cè)系統(tǒng)指導(dǎo)下零射線導(dǎo)管射頻消融治療特發(fā)性右室流出道PVCs(premature ventricular contractions from the right ventricular outflow tract,RVOT-PVCs)的有效性及安全性。方法分析收治的RVOT-PVCs擬行導(dǎo)管射頻消融治療的患者46例,其中三維組21例,其中男9例(43%),女12例(57%),平均年齡(41.7±14.0)歲,運(yùn)用Carto3系統(tǒng)重建右室流出道模型并指導(dǎo)標(biāo)測(cè)及消融;常規(guī)組25例,其中男8例(32%),女17例(68%),平均年齡(41.2±11.5)歲,僅在傳統(tǒng)X線指導(dǎo)下行標(biāo)測(cè)和消融。比較兩組標(biāo)測(cè)時(shí)間、放電次數(shù)、手術(shù)即時(shí)成功率、手術(shù)時(shí)間、X線曝光時(shí)間的差異,并比較遠(yuǎn)期成功率及并發(fā)癥發(fā)生率的差異,并將結(jié)果做統(tǒng)計(jì)學(xué)分析。結(jié)果兩組患者即時(shí)成功率三維組(95.2%)vs.常規(guī)組(92.0%),P0.05,差異無統(tǒng)計(jì)學(xué)意義。與常規(guī)組相比,三維組標(biāo)測(cè)時(shí)間明顯縮短(3.5±0.8)min vs.(6.6±2.7)min,P0.01;放電次數(shù)明顯減少(4.6±1.0)次vs.(8.7±2.5)次,P0.01;手術(shù)時(shí)間明顯縮短(61.1±9.7)min vs.(80.7±34.2)min,P0.05;三維組術(shù)中完全零射線,而常規(guī)組X線曝光時(shí)間為(16.5±8.4)min。隨訪(15±9)個(gè)月,遠(yuǎn)期成功率三維組90.5%,常規(guī)組88.0%,P0.05,差異無統(tǒng)計(jì)學(xué)意義。三維組無手術(shù)相關(guān)并發(fā)癥發(fā)生,常規(guī)組發(fā)生1例心包填塞,經(jīng)心包穿刺置管引流后恢復(fù)。結(jié)論Carto3三維電解剖標(biāo)測(cè)系統(tǒng)指導(dǎo)下行零射線導(dǎo)管射頻消融治療特發(fā)性右室流出道PVCs安全、有效,可較傳統(tǒng)X線指導(dǎo)消融明顯縮短標(biāo)測(cè)時(shí)間、放電次數(shù)及手術(shù)時(shí)間,并可顯著減少射線暴露甚至零射線。
[Abstract]:Background VPB premature ventricular contractionsPVCsis an ectopic pulsatile mediated electrical activity, which can be derived from other cardiac structures outside the atrium. In idiopathic PVCs without structural heart disease, the origin of PVCs mainly comes from the right ventricular outflow tract, while most of the structural heart disease comes from the left ventricle [1] .PVCs may occur in normal persons, with age, The incidence of non-structural heart disease was 6% (2). The prevalence rate of PVCsHolter was 1.3-20% [3]. The most common clinical manifestations were palpitation, palpitation, palpitation, severe arrhythmia, which could lead to black Mongolia, syncope and sudden death. Recent studies have found that frequent PVCs has the potential to cause left ventricular dysfunction and dilated cardiomyopathy [4-9]. Radio Frequency Catheter Ablation RFCA can successfully reverse PVCs related cardiomyopathy. But there is radiation injury in traditional RFCA. RFCA under the guidance of three-dimensional electroanatomy mapping system can minimize the exposure of X-ray in operation, and the operation is more safe, accurate and efficient, and some can even complete the operation under zero ray. Objective to evaluate the efficacy and safety of radiofrequency ablation of PVCs(premature ventricular contractions from the right ventricular outflow tractorius (RVOT-PVCs) guided by Carto3 three-dimensional electroanatomic mapping system in the treatment of idiopathic right ventricular outflow tract (RVO). Methods A total of 46 patients with RVOT-PVCs undergoing radiofrequency catheter ablation were analyzed, including 21 patients in three-dimensional group (9 males and 12 females with mean age of 41.7 鹵14.0). The right ventricular outflow tract model was reconstructed with Carto3 system and the mapping and ablation were guided. There were 25 cases in the routine group, of which 8 cases were males and 17 cases were females, with an average age of 41.2 鹵11.5 years. To compare the difference between the two groups in measuring time, discharge times, immediate success rate of operation and X-ray exposure time, the difference of long-term success rate and complication rate was compared, and the results were analyzed statistically. Results the instant success rate of the two groups was 95. 2% vs. In the routine group, there was no significant difference between the two groups (P 0.05). Compared with the routine group, the mapping time in the 3D group was significantly shortened by 3.5 鹵0.8)min vs.(6.6 鹵2.7 min P0.01, the discharge times were significantly reduced by 4.6 鹵1.0 times, the vs.(8.7 鹵2.5 times, the operative time was significantly shortened by 61.1 鹵9.7)min vs.(80.7 鹵34.2 min P 0.05, and the X-ray exposure time was 16.5 鹵8.4 min in the 3D group. Follow-up for 15 鹵9 months showed that the long-term success rate was 90.5 in the 3D group and 88.0 in the routine group (P0.05). There was no significant difference between the two groups. In the three dimensional group, there were no complications associated with operation, while in the routine group, 1 case had pericardial tamponade and recovered after drainage by pericardial puncture. Conclusion the radiofrequency catheter ablation under the guidance of Carto3 three-dimensional electroanatomic mapping system is safe and effective in the treatment of idiopathic right ventricular outflow tract (PVCs). It can significantly shorten the mapping time, discharge times and operation time compared with conventional X-ray ablation. And can significantly reduce radiation exposure or even zero-ray.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周光春;趙桂芳;龔記葉;白帥;;何慶勇運(yùn)用炙甘草湯治療心悸經(jīng)驗(yàn)[J];中國中醫(yī)藥信息雜志;2015年05期

2 張萍;吳立旗;楊虹婕;李博;徐鳳芹;馬曉昌;;參松養(yǎng)心膠囊治療冠心病室性早搏隨機(jī)對(duì)照試驗(yàn)的系統(tǒng)評(píng)價(jià)[J];中西醫(yī)結(jié)合心腦血管病雜志;2015年04期

3 談?dòng)頹;;疏肝解郁湯治療室性早搏58例[J];河南中醫(yī);2015年04期

4 戚波;;穩(wěn)心顆粒治療室性期前收縮的療效觀察[J];中西醫(yī)結(jié)合研究;2015年01期

5 潘沖;宓丹;;養(yǎng)心湯治療老年室性早博40例臨床療效觀察[J];中國中醫(yī)急癥;2015年02期

6 楊秀禹;;補(bǔ)心湯用于冠心病心悸(室性早搏)中的價(jià)值分析[J];中醫(yī)臨床研究;2015年02期

7 楊琦;蘇文革;;淺談《傷寒論》心悸證治[J];湖南中醫(yī)雜志;2014年12期

8 王紅梅;;蒙西醫(yī)結(jié)合治療心悸癥170例[J];中國民間療法;2014年12期

9 陳羅琦;;八敲療法 寧心安神[J];農(nóng)家之友;2014年07期

10 方任遠(yuǎn);劉晶;儲(chǔ)慧民;何斌;豐明俊;郁一波;;三維標(biāo)測(cè)指導(dǎo)下的陣發(fā)性室上性心動(dòng)過速射頻消融[J];嶺南心血管病雜志;2014年03期

，

本文編號(hào)：1790610