本文選題：冠狀動脈 + 慢性閉塞病變��； 參考：《鄭州大學(xué)》2016年碩士論文

【摘要】：背景QT間期在不同導(dǎo)聯(lián)的差異這一現(xiàn)象早已被發(fā)現(xiàn),在很長時間內(nèi)認為與非同步記錄所造成的測量誤差相關(guān),直到1985年Campbell和Cowan等采用了12導(dǎo)聯(lián)同步記錄心電圖后,才首先證明了這種現(xiàn)象是一種規(guī)律性的存在,最終提出了QT間期離散度(QT dispersion,QTd)的概念,即體表標準12導(dǎo)聯(lián)心電圖不同導(dǎo)聯(lián)間最大QT間期(QTmax)與最小QT間期(QTmin)的差值,是心肌復(fù)極的時間的最大差值。Day等在1990年發(fā)現(xiàn)QTd增大與室性心律失常及猝死密切相關(guān),并提出QTd可作為預(yù)測惡性室性心律失常及猝死的指標。隨后的大量臨床研究進一步明確了QTd的重要臨床意義,至今,QTd已作為了無創(chuàng)性評價心室肌復(fù)極非同步性及反應(yīng)心室肌復(fù)極的不均一性和電不穩(wěn)定性的一個重要指標。冠狀動脈慢性完全閉塞(chronic total occlusions,CTO)病變是指冠狀動脈在粥樣硬化病變基礎(chǔ)上由于血栓形成、機化導(dǎo)致冠狀動脈血管完全阻塞,且閉塞病程超過3個月。冠狀動脈CTO病變是一類常見的冠狀動脈復(fù)雜病變,約占冠狀動脈造影檢出冠狀動脈明顯狹窄患者的20%~30%,隨著操作技術(shù)和器械的發(fā)展,近年來CTO患者接受經(jīng)皮冠脈介入治療(percutaneous coronary intervention,PCI)比例逐漸增加,但僅占全部PCI病例的20%,可見,CTO病變PCI選擇仍有部分爭議。絕大多數(shù)CTO病變都存在同向或者逆向的側(cè)枝循環(huán),使閉塞段遠端保持一定的血供,但,即使側(cè)枝循環(huán)建立充分在功能上也僅相當于90%狹窄的血管,而這些處于缺血狀態(tài)的心肌區(qū)域可能損傷心室肌的復(fù)極。多個臨床研究證實心肌微循環(huán)灌注不足可延長QTd,且成功的血運重建可減少Q(mào)Td。有相關(guān)報道指出CTO經(jīng)PCI成功后可減少Q(mào)Td,但不同冠狀動脈慢性閉塞病變行PCI成功后對QTd影響及對比的研究較少。本實驗旨在通過觀察對比不同冠狀動脈CTO病變開通后對QTd的影響,為CTO病變選擇PCI提供更多的證據(jù)。目的觀察和對比不同冠狀動脈慢性閉塞病變經(jīng)成功PCI后對QTd的影響方法以鄭州大學(xué)第一附屬醫(yī)院心內(nèi)科冠脈造影證實存在至少1支主要冠狀動脈血管(左前降支、回旋支和右冠狀動脈)慢性閉塞病變153例,根據(jù)CTO病變血管分為前降支慢性閉塞組52例、回旋支慢性閉塞組34例、右冠狀動脈慢性閉塞組67例。采用標準同步12導(dǎo)聯(lián)心電圖對所有入組的患者術(shù)前及術(shù)后24小時進行心電圖的測量與臨床資料的采集。采用SPSS19.0統(tǒng)計軟件對三組數(shù)據(jù)進行統(tǒng)計分析。結(jié)果1.三組患者基線資料相比較無統(tǒng)計學(xué)差異(P0.05);2.三組病例經(jīng)成功PCI后QTd、QTcd較術(shù)前均降低(LAD-CTO 43.90±4.61vs.56.40±4.75 P0.001,45.46±4.87 vs.58.40±5.13 P0.001;LCX-CTO40.35±3.26 vs.49.06±4.57 P0.001,42.29±3.22 vs.51.42±4.65 P0.001;RCA-CTO 43.73±4.13 vs.53.97±4.95 P0.001,44.74±4.36 vs.55.22±5.28 P0.001),差異有統(tǒng)計學(xué)意義(P0.05);3.三組PCI前后的QTd、QTcd的差值分別為LAD-CTO(12.50±2.55)ms、(12.95±2.68)ms,LCX-CTO(8.71±2.31)ms、(9.13±2.43)ms,RCA-CTO(10.24±1.81)ms、(10.48±1.89)ms。它們兩兩間比較,差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論CTO病變經(jīng)成功PCI后,QTd、QTcd較術(shù)前降低,且CTO開通前后的QTd、QTcd減少程度由大到小依次為LAD-CTO、RCA-CTO、LCX-CTO。PCI成功開通CTO病變可能對防止快速室性心律失常的發(fā)生及改善臨床預(yù)后具有積極作用。
[Abstract]:The difference of the background QT interval in the different leads has long been found. It is considered to be related to the measurement error caused by the asynchronous record for a long time. Until the 12 lead synchronous recording electrocardiogram was used in the Campbell and Cowan in 1985, it was first proved that this phenomenon was a regular existence, and finally the QT interval was put forward. The concept of QT dispersion (QTd), that is, the difference between the maximum QT interval (QTmax) and the minimum QT interval (QTmin) between the 12 lead electrocardiograms of the body surface standard, the maximum difference between the time of the repolarization of the myocardium, the maximum difference of.Day, and so on, found in 1990 that the increase of QTd is closely related to ventricular arrhythmias and sudden death, and that QTd can be used as a predictor of malignant ventricular arrhythmia. A large number of subsequent clinical studies further clarify the important clinical significance of QTd. To date, QTd has been an important indicator of noninvasive evaluation of ventricular repolarization inhomogeneity and response to ventricular repolarization inhomogeneity and electrical instability. Coronary artery slow complete occlusion (chronic total occlusions, CTO) disease. Change is the coronary artery occlusion on the basis of atherosclerosis on the basis of atherosclerotic lesions, which causes complete occlusion of coronary arteries and the course of occlusion for more than 3 months. Coronary CTO lesion is a common type of complex coronary artery disease, which accounts for 20%~30% of patients with coronary artery stenosis with coronary angiography. In recent years, the proportion of CTO patients receiving percutaneous coronary intervention (percutaneous coronary intervention, PCI) has gradually increased, but only 20% of all PCI cases have been found. It is clear that there is still some controversy in the PCI selection of CTO lesions. Most CTO lesions have the same direction or reverse collateral circulation, which keeps the distal end of the block to a certain amount of blood. Supply, however, even if the collateral circulation is established to fully function as only 90% narrow blood vessels, and these myocardial regions in the ischemic state may damage the repolarization of the ventricular muscle. Multiple clinical studies have confirmed that myocardial microcirculation perfusion deficiency can prolong QTd, and the successful revascularization can reduce QTd. related reports that CTO is successful after PCI. QTd can be reduced, but there are few studies on the effect and contrast of QTd after PCI success in different coronary artery chronic occlusive lesions. This experiment aims to provide more evidence for the selection of PCI in CTO lesions by observing and comparing the effects of different coronary artery CTO lesions on QTd. The purpose of this study is to observe and succeed in the successful P of the chronic occlusion of coronary artery disease. In the Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, there were 153 cases of chronic occlusion of at least 1 main coronary arteries (left anterior descending branch, cyclotron branch and right coronary artery) in the First Affiliated Hospital of Zhengzhou University. 52 cases were divided into anterior descending chronic occlusion group (52 cases), 34 cases of circumflex branch chronic occlusion group and right coronary artery slow down. 67 cases in the sexual block group. The standard synchronous 12 lead electrocardiogram was used to measure the electrocardiogram and the clinical data of all the patients before and after 24 hours after the operation. The data of three groups were statistically analyzed with SPSS19.0 software. The results of the baseline data of the 1. three groups were not statistically different (P0.05); 2. three cases were successful. After PCI, QTd, QTcd decreased compared with pre operation (LAD-CTO 43.90 + 4.61vs.56.40 + 4.75 P0.001,45.46 + 4.87 vs.58.40 + 5.13 P0.001; LCX-CTO40.35 + 3.26 vs.49.06 + 4.57 P0.001,42.29 + 3.22 vs.51.42 4.65), 43.73 + 4.13 + 4.95 + 4.36 + 4.36 The difference between QTd and QTcd before and after PCI was LAD-CTO (12.50 + 2.55) ms, (12.95 + 2.68) ms, LCX-CTO (8.71 + 2.31) ms, (9.13 + 2.43) ms, RCA-CTO (10.24 + 1.81) ms, (10.48 + 1.89) Ms. they were compared, the differences were statistically significant. The successful opening of CTO lesions from large to small to LAD-CTO, RCA-CTO, and LCX-CTO.PCI may have a positive effect on preventing the occurrence of rapid ventricular arrhythmia and improving the clinical prognosis.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.4

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