本文選題：室性早搏 + 不同來源��； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:頻發(fā)室性早搏不僅可影響心室功能,也有可能影響心房功能。射頻消融術(shù)成功治療頻發(fā)室性早搏后大多數(shù)患者左室功能可得到改善,左房容積也較前減小。但對于不同來源頻發(fā)室早對左房結(jié)構(gòu)及功能的影響,及成功消融后4周內(nèi)不同來源室早左房結(jié)構(gòu)及功能是否有變化、變化趨勢是否不同等方面的研究則無明確結(jié)論。本試驗通過對比不同來源頻發(fā)室早患者射頻消融術(shù)前及術(shù)后左心房功能指標(biāo)的變化,了解成功射頻術(shù)后左心房功能變化及不同起源頻發(fā)室早對左心房功能的變化是否影響,從而指導(dǎo)臨床室性早搏治療。方法:順序收集于2014年12月-2015年12月在我院心內(nèi)一科住院,24小時室早總數(shù)10000,且成功行射頻消融術(shù)治療的頻發(fā)室早患者68例.其中右室來源頻發(fā)室性早搏患者41例(年齡:47±15歲;男性15例),左室來源頻發(fā)室性早搏患者27例(年齡:50±17歲;男性16例)。所有入選患者在治療前詢問病史,完善術(shù)前檢查。射頻消融手術(shù)均由同一術(shù)者進(jìn)行,并均行統(tǒng)一術(shù)式即CARTO三維電解剖標(biāo)測系統(tǒng)引導(dǎo)下采用電激動標(biāo)測與起搏標(biāo)測相結(jié)合的方法對PVCs起源位置進(jìn)行精確定位并進(jìn)行消融。所有入選患者均于術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后1個月采用心臟超聲二維斑點追蹤技術(shù)觀察左心房結(jié)構(gòu)和功能指標(biāo)。結(jié)果:1左心房結(jié)構(gòu)指標(biāo)左心房直徑:右室來源組,左房直徑呈緩慢減小趨勢,于術(shù)后2周達(dá)最低點,差異有統(tǒng)計學(xué)意義(P0.05),術(shù)后4周較術(shù)后2周略有升高但較術(shù)前仍有減小的趨勢,且差異均無統(tǒng)計學(xué)意義(P0.05);左室來源組:術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異無統(tǒng)計學(xué)意義(P0.05)。組間比較,術(shù)后右室來源組左房直徑減小有較左室來源組變化更明顯的趨勢,但組間差異無統(tǒng)計學(xué)意義(P0.05)。2左心房功能指標(biāo)左心房射血分?jǐn)?shù):右室來源組術(shù)前左心房射血分?jǐn)?shù)較健康人群顯著降低(63.6±9.3 vs70.3±9.2%,P0.05);術(shù)后左心房射血分?jǐn)?shù)緩慢升高于術(shù)后4周達(dá)最高點,較術(shù)前顯著升高(P0.05);左室來源組:術(shù)前較健康人群降低(60.9±12.2 vs70.3±9.2%,P0.05);術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異無統(tǒng)計學(xué)意義(P0.05)。組間比較,右室來源組左心房射血分?jǐn)?shù)升高有較左室來源組變化更明顯的趨勢,但間差異無統(tǒng)計學(xué)意義(P0.05)。3左心房應(yīng)變指標(biāo)3.1左心房應(yīng)變(Strain S):左右室來源組內(nèi),術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異有統(tǒng)計學(xué)意義(P0.05),各時段左心房應(yīng)變有逐漸增高的趨勢;組間比較,術(shù)前右室來源組及左室來源組間差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后右室來源組各時間段左心房應(yīng)變高于左室來源組(P0.05)。3.2左心房應(yīng)變率(Strain rate SR)3.2.1左心室收縮期(Left ventricular systolic SRs):右室來源組,術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異有統(tǒng)計學(xué)意義(P0.05),各時段SRs有緩慢增高趨勢,于術(shù)后4周達(dá)到最高值;左室來源組內(nèi)比較,術(shù)后1天較術(shù)前顯著減小(P0.05),后逐漸升高,術(shù)后2周較術(shù)前仍有減小趨勢,但差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后4周較術(shù)前有升高趨勢,差異無統(tǒng)計學(xué)意義(P0.05);組間比較,右室來源組術(shù)后SRs升高有優(yōu)于左室來源組的趨勢,但組間差異無統(tǒng)計學(xué)意義(P0.05)。3.2.2左心室舒張早期(Left ventricular diastolic early SRe):組內(nèi)比較,術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異無統(tǒng)計學(xué)意義(P0.05);組間比較,術(shù)前右室來源組及左室來源組間差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后右室來源組各時間段SRe優(yōu)于左室來源組(P0.05)。3.2.3左心房收縮期(Left atrial systolic SRa):右室來源組,術(shù)后1天較術(shù)前略小,差異無統(tǒng)計學(xué)意義(P0.05);后逐漸升高,術(shù)后2周、術(shù)后4周均較術(shù)前顯著升高(P0.05),術(shù)后2周與術(shù)后4周間差異無統(tǒng)計學(xué)意義(P0.05);左室來源組,術(shù)前、術(shù)后1天、術(shù)后2周、術(shù)后4周間差異均無統(tǒng)計學(xué)意義(P0.05);組間比較,右室來源組術(shù)后SRa升高呈優(yōu)于左室來源組的趨勢,但組間差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1右室來源頻發(fā)室早射頻消融術(shù)后2周左房直徑較術(shù)前顯著減小。2左室來源組頻發(fā)室早射頻消融術(shù)后4周內(nèi)左房直徑無明顯變化。3右室來源組頻發(fā)室早射頻消融術(shù)前左房射血功能下降,消融術(shù)后4周后左房射血功能顯著改善,左心房應(yīng)變、應(yīng)變率術(shù)后1天至4周內(nèi)緩慢升高。4左室來源頻發(fā)室早頻消融術(shù)前左房射血功能下降,射頻消融術(shù)后4周內(nèi)左房射血功能無明顯改善,左心房應(yīng)變于術(shù)后1天至4周內(nèi)緩慢升高。5射頻消融術(shù)后,右室來源組左房功能恢復(fù)較顯著。
[Abstract]:Objective: frequent ventricular premature beats can not only affect ventricular function, but also affect atrial function. Radiofrequency ablation can improve left ventricular function in most patients after frequent ventricular premature beats, and the volume of left atrium is smaller than before. However, the effect of different sources on left atrial structure and function in different sources and 4 weeks after successful ablation is not. There is no definite conclusion in the study of whether the structure and function of early left atrium are changed in the same source room, and the change trend is different. This experiment is to compare the changes of the left atrium function before and after the radiofrequency ablation in different sources of frequent ventricular early patients. Whether or not the changes in left atrium function can guide the treatment of ventricular premature beat. Methods: the sequence was collected in a hospital in the heart of our hospital in December -2015 December 2014, the total number of 24 hours room early 10000, and 68 cases of frequent ventricular premature patients who were successfully treated with radiofrequency ablation. 41 cases of right ventricular premature ventricular premature beat (age: 47 + 15 years old) 15 male cases), 27 cases of frequent ventricular premature beat of left ventricular origin (age: 50 + 17 years old; male 16 cases). All the selected patients asked the medical history before the treatment and perfected the preoperative examination. All the radiofrequency ablation operations were all performed by the same operator, and all the patients were guided by the CARTO three-dimensional electric dissection system under the guidance of electric excitation and pacing. The location of PVCs origin was accurately located and ablation. All the patients were selected before operation, 1 days after operation, 2 weeks after operation, and 1 months after the operation, the left atrium structure and function index were observed by echocardiography two dimensional speckle tracking technique. Results: 1 left atrium structure index left atrial diameter: right ventricular source group, left atrial diameter slowly decreasing The trend, 2 weeks after the operation reached the lowest point, the difference was statistically significant (P0.05), 4 weeks after the operation was slightly higher than the 2 weeks after the operation, but the difference was still less than before the operation, and the difference was not statistically significant (P0.05); the left ventricular source group: preoperative, 1 days after operation, 2 weeks after operation, there was no statistical difference between the 4 weeks after the operation (P0.05). Group comparison, right ventricular source group left after operation left The decrease of room diameter was more obvious than that of the left ventricular source group, but there was no significant difference between the groups (P0.05).2 left atrium function index left atrial ejection fraction: the left atrial ejection fraction of the right ventricular source group was significantly lower than that of the healthy group (63.6 + 9.3 vs70.3 + 9.2%, P0.05) before operation, and the left atrium blood fraction of left atrium was slowly higher than that of the postoperative 4 weeks after operation. The highest point was significantly higher than that before operation (P0.05); the left ventricular source group was lower than the healthy population (60.9 + 12.2 vs70.3 + 9.2%, P0.05) before operation; before operation, 1 days after operation, 2 weeks after operation, there was no significant difference between 4 weeks after operation (P0.05). The difference was not statistically significant (P0.05).3 left atrial strain index 3.1 left atrial strain (Strain S): in the left and right ventricular source group, before operation, 1 days after operation, 2 weeks after operation, 4 weeks after operation, there was a statistically significant difference (P0.05), the strain of left atrium increased gradually in each period, and there was no statistical difference between the right ventricular source group and the left ventricular source group before the operation. P0.05, the left atrial strain in the right ventricular source group was higher than that of the left ventricular source group (P0.05).3.2 left atrial strain rate (Strain rate SR) 3.2.1 left ventricular systolic phase (Left ventricular systolic SRs) in the right ventricular source group after operation: the right ventricular source group, 1 days after operation, 2 weeks after the operation, 4 weeks after the operation, there was a significant difference between the 4 weeks after the operation. The increase trend reached the highest value at 4 weeks after the operation, compared with the left ventricular source group, the 1 day after the operation decreased significantly (P0.05), then gradually increased, and then decreased in 2 weeks after the operation, but the difference was not statistically significant (P0.05). The difference was not statistically significant (P0.05) at 4 weeks after the operation, and there was a comparison between the group and the right ventricular source group SRs. There was no statistically significant difference between the groups (P0.05).3.2.2 left ventricular diastolic early diastolic (Left ventricular diastolic early SRe): before operation, 1 days after operation, 2 weeks after operation, there was no statistically significant difference between 4 weeks after operation (P0.05), and there was no difference between the right ventricular source group and the left ventricular source group before operation. Statistical significance (P0.05), after operation, the SRe of right ventricular source group was better than that of left ventricular source group (P0.05).3.2.3 left atrium systolic phase (Left atrial systolic SRa): right ventricular source group, the 1 day after operation was slightly smaller than before operation, the difference was not statistically significant (P0.05); after the operation, 2 weeks after operation, 4 weeks after the operation were significantly higher than before operation (P0.05), 2 weeks after operation and operation after operation. There was no significant difference between the last 4 weeks (P0.05), and there was no significant difference between the left ventricular source group, 1 days after operation, 2 weeks after operation, and 4 weeks after operation (P0.05). The increase of SRa in the right ventricular source group was better than that in the left ventricular source group, but there was no significant difference between the groups (P0.05). Conclusion: 1 the 1 right ventricular sources were in the early radiofrequency ablation. The diameter of left atrium in 2 weeks after operation decreased significantly than that before operation in.2 left ventricular source group. There was no obvious change in the diameter of left atrium within 4 weeks after early radiofrequency ablation. The left atrial ejection function decreased before the early radiofrequency ablation of.3 right ventricular source group. The left atrial ejection function was significantly improved after 4 weeks after ablation, and the strain rate of left atrium was slow from 1 to 4 weeks after operation. The left atrial ejection function decreased before the early frequency ablation of.4 left ventricle. There was no significant improvement in left atrial ejection function within 4 weeks after radiofrequency ablation. Left atrial strain was slowly increased from 1 to 4 weeks after the operation, and the left atrial function in the right ventricular source group was significantly recovered after the operation from 1 to 4 weeks after the operation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.7

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