發(fā)布時(shí)間：2018-06-29 12:09

  本文選題：心房顫動(dòng) + 左心房重構(gòu)��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的采用二維斑點(diǎn)追蹤成像技術(shù)(2D-STI)和實(shí)時(shí)三維超聲心動(dòng)圖(RT-3DE)評(píng)價(jià)不同消融術(shù)式對(duì)房顫患者左心房重構(gòu)的影響。方法將49例陣發(fā)性房顫患者根據(jù)消融術(shù)式不同分為兩組:射頻消融組(RFA)30例,冷凍球囊消融組(CBA)19例。于術(shù)前、術(shù)后3天、術(shù)后1月,應(yīng)用常規(guī)超聲心動(dòng)圖測(cè)量左房?jī)?nèi)徑;應(yīng)用2D-STI檢測(cè)收縮期、舒張?jiān)缙�、舒張晚期左房壁峰值�?yīng)變(Ss、Se、Sa)、應(yīng)變率(SRs、SRe、SRa)及左房整體應(yīng)變(m Ss、m Se、m Sa)、應(yīng)變率(m SRs、m SRe、m SRa);測(cè)量左房各節(jié)段電-機(jī)械傳導(dǎo)時(shí)間(EMT),并計(jì)算左房平均電-機(jī)械傳導(dǎo)時(shí)間(m EMT)及各節(jié)段電-機(jī)械傳導(dǎo)時(shí)間標(biāo)準(zhǔn)差(EMT-SD)。應(yīng)用RT-3DE測(cè)量左房各時(shí)相容積,計(jì)算左房最大容積指數(shù)(LAVImax)、左房最小容積指數(shù)(LAVImin)、左房總射血分?jǐn)?shù)(LATEF)、左房被動(dòng)射血分?jǐn)?shù)(LAPEF)、左房主動(dòng)射血分?jǐn)?shù)(LAAEF)。結(jié)果(1)RFA組與CBA組比較,術(shù)前、術(shù)后3天、術(shù)后1月LAD、LAVImax、LAVImin、LATEF、LAAEF、LAPEF差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)前、術(shù)后1月,兩組間左房各壁及整體應(yīng)變、應(yīng)變率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后3天,CBA組左房各壁Sa、SRa及m Sa、m SRa較RFA組減小(P0.05)。(2)與術(shù)前比較,RFA組術(shù)后3天LAD、LAVImax、LAVImin增大(P0.05),LAAEF、左房各壁及整體應(yīng)變、應(yīng)變率減小(P0.05),左房m EMT、EMT-SD增大(P0.05);術(shù)后1月LAD、LAVImax、LAVImin減小(P0.05),左房后壁應(yīng)變及應(yīng)變率減小(P0.05),左房m EMT縮短(P0.05)。與術(shù)后3天比較,RFA組術(shù)后1月LAD、LAVImax、LAVImin減小(P0.05),LATEF、LAAEF、LAPEF增大(P0.05),左房側(cè)壁、間隔壁、前壁、下壁及整體應(yīng)變、應(yīng)變率增大(P0.05),左房m EMT、EMT-SD減小(P0.05)。(3)與術(shù)前比較,CBA組術(shù)后3天LAVImin增大(P0.05),LATEF、LAAEF減小(P0.05),左房各壁及整體應(yīng)變、應(yīng)變率減低(P0.05),且后壁Ss、Sa、SRs、SRa顯著減低(P0.01),左房m EMT、EMT-SD增大(P0.05);術(shù)后1月LAD、LAVImax、LAVImin減小(P0.05),左房后壁Ss、Sa、SRs、SRa減低(P0.05),左房m EMT縮短(P0.05)。與術(shù)后3天比較,CBA組術(shù)后1月LAD、LAVImax、LAVImin、減小(P0.05),LATEF、LAAEF、LAPEF增大(P0.05),左房各壁及整體應(yīng)變、應(yīng)變率增大(P0.05),左房m EMT、EMT-SD減低(P0.05)。結(jié)論(1)RFA和CBA兩種消融術(shù)式對(duì)房顫患者左房結(jié)構(gòu)、功能、電重構(gòu)的影響在術(shù)后1月無(wú)明顯差異。(2)RFA組和CBA組術(shù)后3天均出現(xiàn)左房頓抑,導(dǎo)致左房增大,左房存儲(chǔ)功能、管道功能、輔助泵功能降低;術(shù)后3天,CBA組左房輔助泵功能較RFA組降低更明顯。(3)消融術(shù)后1月,RFA組和CBA組左房結(jié)構(gòu)重構(gòu)及電重構(gòu)均發(fā)生逆轉(zhuǎn),但左房功能重構(gòu)與術(shù)前比較未見(jiàn)明顯改善,且左房后壁應(yīng)變、應(yīng)變率較術(shù)前減低。
[Abstract]:Objective to evaluate the effects of different ablation methods on left atrial remodeling in patients with atrial fibrillation by two dimensional speckle tracing imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE). Methods 49 patients with paroxysmal atrial fibrillation were divided into two groups: radiofrequency ablation (RFA) group (30 cases) and cryopreservation balloon ablation group (CBA) (19 cases). The left atrial diameter was measured by routine echocardiography before operation, 3 days after operation, 1 month after operation, 2D-STI was used to detect systolic phase and early diastolic phase. Peak strain of left atrial wall in late diastolic stage (SsSe Se Sa), strain rate (SRS), global strain of left atrium (m Ssm Sem sa), strain rate (m SRsm SRem SRa), electromechanical conduction time (EMT) of each segment of left atrium were measured, and mean electromechanical conduction time (mEMT) of left atrium was calculated and the mean electromechanical conduction time (mEMT) of left atrium was calculated by measuring the mean electromechanical conduction time (mEMT) of left atrium and calculating the mean electromechanical conduction time (mEMT) of left atrium. Standard deviation of conduction time (EMT-SD). The left atrial maximum volume index (LAVImax), left atrial minimum volume index (LAVImin), left atrial total ejection fraction (LATEF), left atrial passive ejection fraction (LAPEF) and left atrial active ejection fraction (LAAEF) were measured by RT-3DE. Results (1) there was no significant difference in LAPEF between RFA group and CBA group before operation, 3 days after operation and 1 month after operation (P0.05). There was no significant difference in strain rate (P0.05), SAA SRa and m SaomSRa in left atrial wall decreased in CBA group 3 days after operation (P0.05). (2) and LAVImax LAVImin increased 3 days after operation (P0.05), left atrial wall and global strain increased. Strain rate decreased (P0.05), left atrial mEMTT EMT-SD increased (P0.05), LAVImaxl LAVImin decreased (P0.05), left atrial posterior wall strain and strain rate decreased (P0.05), left atrial mEMT shortened (P0.05). Compared with 3 days after operation, LAVImaxand LAVImin decreased in RFA group (P0.05). LATEFN LAAEFF LAPEF increased (P0.05), left atrial lateral wall, adnexal wall, anterior wall, inferior wall and global strain. The strain rate increased (P0.05), the left atrial m EMTN EMT-SD decreased (P0.05). (3), the LAVImin increased 3 days after operation (P0.05), the LAAEF decreased (P0.05), the left atrial wall and global strain decreased. The strain rate was decreased (P0.05), and the SRA in the posterior wall was significantly decreased (P0.01), and the left atrial mEMT-EMT-SD was increased (P0.05), but LAVImaxLAVImin was decreased (P0.05), the Sssfen SaSSASRssSMA SRA was decreased (P0.05), and the left atrial mEMT was shortened (P0.05) in the posterior wall of left atrium. Compared with 3 days after operation, LAVImaxlavimin decreased (P0.05), left atrial wall strain and overall strain increased (P0.05), left atrial mEMT-EMT-SD decreased (P0.05) in CBA group. Conclusion (1) the effects of RFA and CBA on left atrial structure, function and electrical remodeling in patients with atrial fibrillation were not significantly different at one month after operation. (2) left atrial arrest occurred in RFA group and CBA group 3 days after operation, resulting in left atrial enlargement, left atrial storage function and conduit function. The left atrial auxiliary pump function in CBA group was significantly lower than that in RFA group 3 days after operation. (3) the left atrial structure remodeling and electrical remodeling were reversed in RFA group and CBA group at 1 month after ablation, but left atrial function remodeling was not significantly improved compared with that before operation. The strain and strain rate of the posterior wall of left atrium were lower than those before operation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.75

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 羅田田;張萍;;超聲心動(dòng)圖新技術(shù)評(píng)價(jià)房顫患者左心房結(jié)構(gòu)和功能的研究進(jìn)展[J];中國(guó)介入影像與治療學(xué);2015年04期

2 顧俊;胡偉;劉旭;;心房重構(gòu)研究進(jìn)展[J];國(guó)際心血管病雜志;2014年06期

3 史琪;穆玉明;唐琪;閆雪;吳軍剛;;實(shí)時(shí)三維超聲及斑點(diǎn)追蹤技術(shù)評(píng)價(jià)心房顫動(dòng)患者射頻消融術(shù)前后左心房功能[J];中華超聲影像學(xué)雜志;2011年08期

4 曹省;陳金玲;周青;胡波;黃佳;郭瑞強(qiáng);;二維斑點(diǎn)追蹤顯像技術(shù)評(píng)價(jià)陣發(fā)性心房顫動(dòng)患者左心房功能和同步性的研究[J];中華超聲影像學(xué)雜志;2013年03期

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本文編號(hào)：2082065