本文選題：心房頓抑 + 左心房功能　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:心房顫動(dòng)是臨床上較為常見的心律失常之一,眾多研究顯示,房顫轉(zhuǎn)為竇性心律后一段時(shí)間內(nèi)存在栓塞風(fēng)險(xiǎn),其原因和即使轉(zhuǎn)復(fù)竇律后依舊存在心房頓抑及心房功能恢復(fù)不全有關(guān)。心房頓抑是指房顫和房撲轉(zhuǎn)為竇性心律后出現(xiàn)心房、心耳機(jī)械功能暫時(shí)性的失調(diào)[11]。隨著導(dǎo)管介入技術(shù)的發(fā)展,射頻消融術(shù)已成為近年來(lái)針對(duì)房顫進(jìn)行的先進(jìn)的介入治療手術(shù)。然而因房顫射頻消融術(shù)后一段時(shí)間內(nèi)仍存在心房頓抑及左心房功能不全[1],因此在一定程度上影響了房顫射頻消融的治療效果。而心房頓抑的確切機(jī)制、持續(xù)時(shí)間、如何減少房顫射頻消融術(shù)后心房頓抑及盡快改善左心房功能成為目前國(guó)內(nèi)外研究的熱點(diǎn),且沒(méi)有明確的結(jié)論。有研究認(rèn)為炎癥和氧化應(yīng)激在房顫的發(fā)生中起到重要作用[2-4],并且心房頓抑可能與心房肌細(xì)胞的炎癥、氧化應(yīng)激、纖維化等有關(guān)[5]。另外,近年來(lái)人們發(fā)現(xiàn)他汀類藥物除具有降脂作用外,還有抗炎、抗氧化、改善心肌重構(gòu)、抗心肌纖維化等作用。但他汀是否能改善房顫射頻消融術(shù)后的左房頓抑和功能目前尚不知曉。因此本試驗(yàn)選用阿托伐他汀鈣,用于房顫射頻消融的病人,比較他汀組及非他汀兩組患者房顫射頻消融術(shù)后的左房功能的變化及心房頓抑的發(fā)生,觀察其是否能改善左心房的功能,減輕心房頓抑的發(fā)生。并試圖研究房顫射頻消融術(shù)后心房頓抑的機(jī)制及具體時(shí)間。這可為房顫的臨床治療提供依據(jù)。方法:研究對(duì)象為2013年12月-2015年1月在河北醫(yī)科大學(xué)第二醫(yī)院心內(nèi)一科住院的房顫且擬行射頻消融手術(shù)的患者,包括持續(xù)性房顫及陣發(fā)性房顫患者,共49例。隨機(jī)分為他汀組和非他汀組。他汀組:手術(shù)前3~4天在常規(guī)房顫治療基礎(chǔ)上加用阿托伐他汀鈣(輝瑞醫(yī)藥)20mg口服1/晚;非他汀組:采用房顫常規(guī)治療。所有入選患者在治療前經(jīng)病史詢問(wèn)、體格檢查、實(shí)驗(yàn)室檢查、常規(guī)心電圖及動(dòng)態(tài)心電圖檢查、經(jīng)食道心臟彩超檢查等術(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)式即環(huán)肺靜脈隔離術(shù)。如術(shù)中因特殊情況改變術(shù)式則從本研究中剔除。所有患者分別于術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周采用心臟超聲二維斑點(diǎn)追蹤技術(shù)觀察心房頓抑和左房功能指標(biāo)。數(shù)據(jù)采用SPSS13.0進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料服從正態(tài)分布時(shí)用均數(shù)±標(biāo)準(zhǔn)差(x—±s)表示,非正態(tài)分布時(shí)采用中位數(shù)(四分位數(shù)間距)表示,即M(QR)。組間及組內(nèi)比較采用重復(fù)測(cè)量混合線性模型進(jìn)行比較,相關(guān)因素分析采用多元線性回歸分析,均數(shù)比較采用t檢驗(yàn)。P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果:所有病例均成功完成房顫射頻消融術(shù),術(shù)式均為環(huán)肺靜脈隔離術(shù),無(wú)肺靜脈狹窄、血栓栓塞事件、心包填塞、左房食管瘺等并發(fā)癥。1兩組患者的一般情況非他汀組患者男性18例,女性10例,陣發(fā)性房顫19例,持續(xù)性房顫9例;他汀組患者男性14例,女性7例,陣發(fā)性房顫14例,持續(xù)性房顫7例;兩組患者年齡、性別、陣發(fā)性及持續(xù)性比例差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2心臟超聲指標(biāo):2.1左心房結(jié)構(gòu)指標(biāo):左心房直徑(LAD):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.2心臟功能指標(biāo)2.2.1左心房射血分?jǐn)?shù)(LAEF%):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異有統(tǒng)計(jì)學(xué)意義(P0.05),他汀組術(shù)后1周明顯低于術(shù)前(P0.05),術(shù)后2周逐漸升高,但依然低于術(shù)前(P0.05),術(shù)后3周與術(shù)前比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后4周高于術(shù)前(P0.05);非他汀組術(shù)后1周、2周、3周LAEF%逐漸升高,但均低于術(shù)前(P0.05),術(shù)后4周與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后4周高于術(shù)前;組間比較,他汀組在術(shù)后各時(shí)間段LAEF%均高于非他汀組(P0.05)。2.2.2 A峰:組內(nèi)比較,他汀組及非他汀組術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異有統(tǒng)計(jì)學(xué)意義(P0.05),各時(shí)間段A峰有逐漸增高的趨勢(shì);組間比較,他汀組及非他汀組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),他汀組在術(shù)后各時(shí)間段A峰均高于非他汀組。2.2.3 E峰:組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.2.4 E/A值:組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異有統(tǒng)計(jì)學(xué)意義(P0.05),他汀組及非他汀組術(shù)后各時(shí)間段較術(shù)前有升高趨勢(shì);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.2.5 A峰速度時(shí)間積分(A-VTI):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間無(wú)明顯差異(P0.05)。2.2.6 e’:組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.3左心房應(yīng)變指標(biāo):2.3.1左心房應(yīng)變(S):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),他汀組術(shù)后各時(shí)間段左心房應(yīng)變高于非他汀組。2.3.2左心房應(yīng)變率(SR)2.3.2.1左心室收縮期(SRs):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),組間他汀組及非他汀組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),他汀組術(shù)后各時(shí)間段左心房應(yīng)變率在左心室收縮期顯著高于非他汀組。2.3.2.2左心室舒張?jiān)缙?SRe):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.3.2.3左心房收縮期(SRa):組內(nèi)比較,術(shù)前、術(shù)后1周、術(shù)后2周、術(shù)后3周、術(shù)后4周間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);組間比較,他汀組及非他汀組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3左房功能與年齡、左房直徑(LAD)、是否用他汀、血漿低密度脂蛋白(LDL-c)相關(guān)性分析結(jié)果:LAEF:術(shù)后1周與LAD、是否用他汀相關(guān)(P0.05);術(shù)后2周、3周、4周僅與LAD相關(guān)(P0.05)。A峰:術(shù)后1周與LAD、年齡相關(guān)(P0.05);術(shù)后2周與是否用他汀相關(guān)(P0.05);術(shù)后3周與LAD、年齡、是否用他汀、血漿低密度脂蛋白(LDL-c)都不相關(guān)(P0.05);術(shù)后4周與年齡、LAD相關(guān)(P0.05)。結(jié)論:1房顫射頻消融術(shù)后一段時(shí)間內(nèi)存在左心房頓抑及左心房功能下降,且術(shù)后第1周最明顯,以后逐漸恢復(fù),因此房顫射頻消融術(shù)后需要抗凝治療,術(shù)后第1周最重要。2非他汀組房顫射頻消融術(shù)后左心房頓抑及左心房功能下降持續(xù)約4周,因此至少需抗凝4周。3他汀組房顫射頻消融術(shù)后左心房頓抑及左心房功能下降持續(xù)約3周,因此至少需抗凝3周,且術(shù)后1周、2周、3周、4周左心房射血分?jǐn)?shù)均得到改善。4阿托伐他汀鈣可以改善房顫射頻消融術(shù)后左心房功能、縮短心房頓抑的時(shí)間。
[Abstract]:Objective: atrial fibrillation is one of the most common arrhythmias in the clinic. Numerous studies have shown that atrial fibrillation is involved in the risk of embolization at a time after sinus rhythm. The cause is associated with atrial stunning and atrial functional recovery even after the cardioversion sinus rhythm. Atrial stunning refers to atrial fibrillation and atrial flutter after sinus rhythm. [11]. has become an advanced interventional therapy for atrial fibrillation in recent years with the development of interventional catheter technology. However, there is still atrial stunning and left atrial dysfunction [1] for a period of time after radiofrequency ablation for atrial fibrillation, so it affects atrial fibrillation to a certain extent. The exact mechanism and duration of atrial stunning, duration, how to reduce atrial stunning after radiofrequency ablation and improve the function of the left atrium as soon as possible after radiofrequency ablation of atrial fibrillation has become a hot spot at home and abroad, and there is no clear conclusion. It is considered that inflammation and oxidative stress play an important role in the occurrence of atrial fibrillation, [2-4], and Atrial stunning may be associated with [5]. in atrial myocyte inflammation, oxidative stress, and fibrosis. In recent years, statins have been found to have anti-inflammatory, antioxidant, myocardial remodeling, and anti myocardial fibrosis in addition to lipid lowering in recent years. But whether statins can improve left atrial stunning and function after atrial fibrillation radiofrequency ablation Therefore, atorvastatin calcium was used in this study to compare the changes of left atrial function and the occurrence of atrial stunning after radiofrequency ablation in statins and non statin groups in patients with atrial fibrillation radiofrequency ablation, and to observe whether they could improve the function of the left atrium, reduce the occurrence of atrial stunning, and try to study the radiofrequency of atrial fibrillation. The mechanism and specific time of atrial stunning after ablation can provide a basis for clinical treatment of atrial fibrillation. Methods: a total of 49 patients, including persistent atrial fibrillation and paroxysmal atrial fibrillation, were randomly divided into 49 patients who were hospitalized at the heart of the second hospital of Hebei Medical University, December 2013, in the second hospital of Hebei Medical University, including patients with persistent atrial fibrillation and paroxysmal atrial fibrillation. Statins and non statins. Statins group: atorvastatin calcium (Pfizer) 20mg was added to 1/ night on the basis of conventional atrial fibrillation therapy 3~4 days before the operation; non statin group was treated with atrial fibrillation routine treatment. All selected patients underwent medical history inquiry, physical examination, laboratory examination, routine electrocardiogram and dynamic electrocardiogram examination before treatment, through esophagus. Radiofrequency ultrasound examination, such as preoperative examination. Radiofrequency ablation was performed by the same surgeon, and all the patients were treated by a unified surgical method of circumferential pulmonary vein isolation. For example, the surgical procedure was removed from this study. All patients were removed from the study, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, and two dimensional echocardiography after 4 weeks after operation. The indexes of atrial stunning and left atrial function were observed. The data were statistically analyzed by SPSS13.0, and the data were expressed with mean mean + standard deviation (x - s) when the measurement data were subject to normal distribution. The median (four quantile spacing) was expressed in the non normal distribution, that is, M (QR). Multivariate linear regression analysis was used, and the average number was compared with t test.P0.05. Results: all cases successfully completed atrial fibrillation radiofrequency ablation successfully. All cases were circumferential pulmonary vein isolation, no pulmonary vein stenosis, thromboembolism events, pericardial tamponade, left atrial esophagus fistula and other complications in the two groups of non statins. There were 18 male, 10 female, 19 paroxysmal atrial fibrillation, 9 persistent atrial fibrillation, 14 statins, 7 female, 14 paroxysmal atrial fibrillation and 7 patients with persistent atrial fibrillation (7 cases). The difference of age, sex, paroxysmal and persistent ratio in the two group was not statistically significant (P0.05).2 cardiac ultrasound index: 2.1 left atrium index: left atrium diameter (left atrium diameter). LAD): in group comparison, there was no statistically significant difference between 1 weeks after operation, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05). The difference between statin group and non statin group was not statistically significant (P0.05).2.2 cardiac function 2.2.1 left atrial ejection fraction (LAEF%): group comparison, preoperative, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, and 4 weeks postoperative difference after operation. The difference was statistically significant (P0.05). 1 weeks after operation in statin group was significantly lower than that before operation (P0.05), and gradually increased in 2 weeks after operation, but still lower than before operation (P0.05). There was no statistical difference between 3 weeks after operation (P0.05) and 4 weeks after operation (P0.05), and 1 weeks, 2 weeks and 3 weeks after operation in non statin group, but lower than before operation (P0.05) and 4 weeks after operation. The difference was statistically significant (P0.05), and 4 weeks after operation was higher than that before the operation. The LAEF% in the statins group was higher than that of the non statin group (P0.05).2.2.2 A peak after the operation. The difference between the statin group and the non statin group was statistically significant (P0.05) at 4 weeks after the operation, 3 weeks after the operation, and 4 weeks after the operation (P0.05), and the A peak in each time period. The tendency to increase gradually; the difference between statin group and non statin group was statistically significant (P0.05), and the A peak of statins group was higher than that of non statin group.2.2.3 E peak in all time periods after operation: before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks postoperatively and 4 weeks after operation, the difference was not statistically significant (P0.05); statin group and non statin group were compared. There was no statistically significant difference (P0.05).2.2.4 E/A value: before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, 4 weeks after operation, there was a statistically significant difference (P0.05). The difference between statin group and non statin group was higher than that before operation, and there was no statistically significant difference (P0.05).2.2.5 A peak speed between the statin group and the non statin group. Degree time integral (A-VTI): in group comparison, there was no significant difference between preoperative, 1 weeks, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05); there was no significant difference between statin group and non statin group (P0.05).2.2.6 e: group comparison, before operation, 1 weeks after operation, 2 weeks postoperatively, 3 weeks after operation (P0.05), and there was no significant difference between the groups (P0.05). Comparison, there was no significant difference between statin group and non statin group (P0.05).2.3 left atrial strain index: 2.3.1 left atrial strain (S): before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, there was no significant difference between 4 weeks after operation (P0.05); the difference between statin group and statin group was statistically significant (P0.05), statins group The left atrial strain was higher than the left atrial strain rate (SR) 2.3.2.1 left ventricular systolic phase (SRs) of the left atrium (.2.3.2) in the non statin group. The difference was not statistically significant (P0.05) before the operation, 1 weeks after the operation, 2 weeks after the operation, 3 weeks after the operation (P0.05), and the difference between the statin group and the statin group was statistically significant (P0.05). The left atrial strain rate in the left ventricle was significantly higher than that in the left ventricular diastolic early diastolic phase (SRe) in the left ventricular systole (.2.3.2.2). The difference was not statistically significant (P0.05) before the operation, 1 weeks after operation, 2 weeks after the operation, 3 weeks after the operation and 4 weeks after the operation. There was no statistically significant difference between the statin group and the non statin group (P0.05).2.3.2.3 left atrium systolic phase. (SRa): in group comparison, there was no statistically significant difference between preoperative, 1 weeks, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05). There was no statistically significant difference between statins and non statin groups (P0.05).3 left atrial function and age, left atrial diameter (LAD), statins and plasma low density lipoprotein (LDL-c) correlation analysis: 1 after LAEF: Week and LAD, statins correlation (P0.05); 2 weeks, 3 weeks after operation, 4 weeks only with LAD (P0.05).A peak: 1 weeks after operation, age related (P0.05); 2 weeks after operation with statin related (P0.05); 3 weeks and LAD after operation, age, statins, plasma low density lipoprotein (LDL-c) are not related (P0.05); 4 weeks after 4 weeks with age, LAD related. Junctions. 1 after radiofrequency ablation of atrial fibrillation, the left atrium and left atrium were depressed and the left atrium function decreased, and the most obvious after first weeks after operation, and then gradually resumed. Therefore, anticoagulant therapy was needed after radiofrequency ablation of atrial fibrillation. The most important.2 non statins group after radiofrequency ablation was the left atrial stunning and left atrial function decline for about 4 weeks after the ablation of atrial fibrillation. Therefore, at least 4 weeks of anticoagulant.3 statin group, left atrial stunning and left atrium function decline lasted about 3 weeks after radiofrequency ablation, and at least 3 weeks of anticoagulation, and 1 weeks, 2 weeks, 3 weeks and 4 weeks of left atrial ejection fraction were improved by.4 atorvastatin calcium to improve left atrial function after AF ablation and shorten atrial stunning. Room.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.75

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