【摘要】：目的心房顫動(dòng)(atrial fibrillation,簡(jiǎn)稱(chēng)房顫)是快速性房性心律失常之中最常見(jiàn)的類(lèi)型。房顫患者的發(fā)病率隨著中國(guó)乃至全球老齡化人群的增長(zhǎng)呈現(xiàn)上升走勢(shì),當(dāng)前國(guó)內(nèi)外研究資料顯示,房顫儼然已成為了一個(gè)重大的公共衛(wèi)生問(wèn)題,尤其是持續(xù)性房顫(persistent atrial fibrillation,PeAF)嚴(yán)重影響到人們的生活質(zhì)量。盡管射頻消融術(shù)(radiofrequency catheter ablation,RFCA)能有效治療陣發(fā)性房顫,但是,目前RFCA治療PeAF的療效卻不盡如人意,其術(shù)后復(fù)發(fā)率高。本論文對(duì)在我院完成RFCA治療的PeAF患者的術(shù)前體表心電圖(electrocardiogram,ECG))f波振幅進(jìn)行分析,評(píng)價(jià)其對(duì)RFCA治療PeAF的療效。方法連續(xù)選取2014年9月至2016年9月間就診于山東大學(xué)附屬千佛山醫(yī)院,首次接受RFCA治療的非瓣膜病持續(xù)性房顫患者31例。收集PeAF患者RFCA術(shù)前的一般臨床資料(例如:性別、年齡、房顫持續(xù)時(shí)間以及左房?jī)?nèi)徑等),測(cè)量PeAF患者術(shù)前體表心電圖Ⅱ、AVF以及V1導(dǎo)聯(lián)的f波振幅,并對(duì)完成RFCA的房顫患者進(jìn)行隨訪(fǎng),根據(jù)術(shù)后是否復(fù)發(fā)將患者分為兩組:復(fù)發(fā)組(11例)以及未復(fù)發(fā)組(20例),分析PeAF患者RFCA術(shù)前相關(guān)臨床指標(biāo)對(duì)RFCA術(shù)后復(fù)發(fā)的影響,計(jì)算預(yù)測(cè)PeAF患者RFCA術(shù)后復(fù)發(fā)的臨床指標(biāo)的ROC曲線(xiàn)下面積,預(yù)測(cè)指標(biāo)的界值,特異度及靈敏度。結(jié)果與PeAF患者RFCA術(shù)后復(fù)發(fā)組相比,未復(fù)發(fā)組術(shù)前體表心電圖AVF導(dǎo)聯(lián)f波平均振幅[(0.087±0.012)mVvs.(0.117±0.024)mV,P=0.001]以及 V1導(dǎo)聯(lián)f波平均振幅[(0.091±0.018)mVvs.(0.130±0.025)mV,P0.001]較前者高,并且,未復(fù)發(fā)組房顫平均持續(xù)時(shí)間[(28.36± 16.05)月vs.(16.35±12.61)月,P0.05]較前者短,差異均有統(tǒng)計(jì)學(xué)意義。Pearson相關(guān)性分析顯示:房顫平均持續(xù)時(shí)間與PeAF患者RFCA術(shù)前體表心電圖AVF導(dǎo)聯(lián)f波平均振幅呈線(xiàn)性負(fù)相關(guān)(r=-0.371,P=0.040),而且,與V1導(dǎo)聯(lián)f波平均振幅呈線(xiàn)性負(fù)相關(guān)(r=-0.394,P=0.028),PeAF患者RFCA術(shù)前體表心電圖AVF導(dǎo)聯(lián)f波平均振幅以及V,導(dǎo)聯(lián)平均振幅呈線(xiàn)性正相關(guān)(r=0.444,P=0.012)。多因素Logistic回歸分析顯示:房顫平均持續(xù)時(shí)間[P=0.048,OR=1.086,OR 95%C.I.(1.001,1.178)]以及 PeAF 患者RFCA術(shù)前體表心電圖V,導(dǎo)聯(lián)f波平均振幅[P = 0.040,OR = 0.270,OR 95%C.I.(0.078,0.940)]是預(yù)測(cè)RFCA術(shù)后復(fù)發(fā)的危險(xiǎn)因素。ROC曲線(xiàn)顯示:房顫平均持續(xù)時(shí)間預(yù)測(cè)PeAF患者RFCA術(shù)后復(fù)發(fā)的ROC曲線(xiàn)下面積為0.736(P=0.032),其預(yù)測(cè)RFCA術(shù)后復(fù)發(fā)的界值、特異度及敏感度分別為13.5個(gè)月,60%,81.8%。V,導(dǎo)聯(lián)f波平均振幅預(yù)測(cè)PeAF患者RFCA術(shù)后復(fù)發(fā)的ROC曲線(xiàn)下面積為0.898(P0.001),其預(yù)測(cè)術(shù)后復(fù)發(fā)的界值、特異度及敏感度分別為0.095mV,95%,72.7%。結(jié)論RFCA術(shù)前房顫持續(xù)時(shí)間以及術(shù)前體表心電圖V,導(dǎo)聯(lián)f波振幅可作為預(yù)測(cè)PeAF患者術(shù)后復(fù)發(fā)的預(yù)測(cè)指標(biāo),具有一定的臨床參考價(jià)值。PeAF患者RFCA術(shù)前V1導(dǎo)聯(lián)f波振幅低、房顫持續(xù)時(shí)間長(zhǎng)的患者,RFCA術(shù)后更易復(fù)發(fā)。
[Abstract]:Objective Atrial fibrillation (atrial fibrillation,) is the most common type of atrial tachyarrhythmia. The incidence of atrial fibrillation (AF) patients is increasing with the increase of aging population in China and even the whole world. Current research data at home and abroad show that AF has become a major public health problem, especially persistent atrial fibrillation (persistent atrial fibrillation,). PeAF seriously affects people's quality of life. Although radiofrequency ablation (radiofrequency catheter ablation,RFCA) can effectively treat paroxysmal atrial fibrillation, the efficacy of RFCA in the treatment of PeAF is not satisfactory, and its recurrence rate is high. In this paper, we analyzed the amplitude of electrocardiogram,ECG) f wave in PeAF patients who completed RFCA treatment in our hospital, and evaluated the effect of RFCA on PeAF. Methods from September 2014 to September 2016, 31 patients with persistent atrial fibrillation who were treated with RFCA for the first time at Qianfushan Hospital affiliated to Shandong University were selected. To collect general clinical data (such as gender, age, duration of atrial fibrillation and left atrial diameter, etc.) before RFCA in patients with PeAF, and to measure the amplitude of F-wave of electrocardiogram 鈪，

本文編號(hào)：2314170