慢徑消融后快徑前傳及逆?zhèn)鞴δ茏兓难芯?/H1>
發(fā)布時(shí)間：2019-01-26 08:24
【摘要】：目的：本研究旨在在前人研究的基礎(chǔ)上,通過(guò)嚴(yán)格控制研究條件,創(chuàng)新觀察指標(biāo),增加對(duì)AVNRT患者慢徑消融后逆?zhèn)鞴δ艿难芯拷嵌?探討慢快型房室結(jié)折返性心動(dòng)過(guò)速(SF-AVNRT)患者慢徑消融后快徑傳導(dǎo)功能的變化,進(jìn)而通過(guò)觀察慢徑消融后快徑傳導(dǎo)功能的變化來(lái)推測(cè)房室結(jié)快徑及慢徑之間的關(guān)系,為日后房室結(jié)確切結(jié)構(gòu)的進(jìn)一步研究提供可靠的電生理方面的依據(jù)。方法：對(duì)2013年11月至2014年8月112例因發(fā)作性心悸在我科住院的患者進(jìn)行心腔內(nèi)電生理檢查,其中48例電生理檢查確診為有明顯跳躍現(xiàn)象的SF-AVNRT。對(duì)這48例患者電極重新放置至標(biāo)準(zhǔn)位置,然后行高位右房(HRA)刺激S1S1 500ms刺激,測(cè)定Hisl、2級(jí)AH間距,即房室結(jié)的傳導(dǎo)時(shí)間,行S1S2刺激記錄房室結(jié)的跳躍點(diǎn)以及測(cè)量跳躍值,以該跳躍點(diǎn)為AVNRT患者術(shù)前快徑的有效不應(yīng)期(ERP前)。行RV S1S1 500ms刺激測(cè)定His1、2極HA間距作為房室結(jié)的逆?zhèn)鲿r(shí)間,行S1S2刺激記錄房室結(jié)逆?zhèn)魈S點(diǎn)以及測(cè)定房室結(jié)逆?zhèn)饔行Р粦?yīng)期(ERP逆)不應(yīng)期。然后對(duì)患者性慢徑射頻消融術(shù),常規(guī)采用下位法消融,以出現(xiàn)慢結(jié)性心律為有效,以HRA S1S2刺激無(wú)AH跳躍,無(wú)房室結(jié)折返為手術(shù)的終點(diǎn)。術(shù)后再將電極送至術(shù)前的標(biāo)準(zhǔn)位置,行HRA S1S1 500ms刺激測(cè)定房室結(jié)的傳導(dǎo)時(shí)間(TFP前),行S1S2刺激測(cè)定房室結(jié)的有效不應(yīng)期(ERPFP前),此時(shí)房室結(jié)的不應(yīng)期即為快徑的有效不應(yīng)期,行RV S1S1500ms刺激測(cè)定房室結(jié)的逆?zhèn)鲿r(shí)間,行S1S2刺激測(cè)定房室結(jié)逆?zhèn)鞯挠行Р粦?yīng)期(ERPFP前),比較術(shù)前術(shù)后快徑的傳導(dǎo)時(shí)間、有效不應(yīng)期是否有變化,然后根據(jù)研究結(jié)果推測(cè)房室結(jié)快慢徑之間的關(guān)系。結(jié)果：1、入選的48例患者均手術(shù)成功,均未出現(xiàn)并發(fā)癥,術(shù)后重復(fù)心內(nèi)電生理檢查均無(wú)明顯AH跳躍,亦未誘發(fā)任何心動(dòng)過(guò)速發(fā)作及房室結(jié)單個(gè)折返,達(dá)到慢徑完全消融慢徑的標(biāo)準(zhǔn)。2、入選的48例患者快徑前向傳導(dǎo)時(shí)間(TFP前)由術(shù)前的106.04-+36.36ms縮短為術(shù)后89.98-+27.09ms,p0.001,差異具有統(tǒng)計(jì)學(xué)意義；3、快徑前向傳導(dǎo)的有效不應(yīng)期(ERPFP前)由術(shù)前330.00±53.31ms縮短為術(shù)后250.21-±56.81ms,P0.001,差異具有統(tǒng)計(jì)學(xué)意義；4、快徑逆向傳導(dǎo)時(shí)間(TFP逆)由術(shù)前的94.54+28.39ms縮短至術(shù)后86.62+24.88ms,P=-0.010,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論：房室結(jié)折返性心動(dòng)過(guò)速患者慢徑消融后快徑前向及逆向傳導(dǎo)功能均得到改善。慢徑及快徑并不是相互獨(dú)立存在的結(jié)構(gòu),而是相互影響,相互聯(lián)系的,慢徑的存在抑制了快徑的傳導(dǎo)。
[Abstract]:Objective: the purpose of this study was to increase the research angle of retrograde transmission after slow pathway ablation in patients with AVNRT by strictly controlling the research conditions and innovating the observation indexes on the basis of previous studies. To investigate the changes of fast pathway conduction function after slow pathway ablation in patients with slow fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), and to speculate the relationship between atrioventricular nodal fast pathway and slow pathway by observing the changes of fast path conduction function after slow pathway ablation. It provides reliable electrophysiological basis for further study on the exact structure of atrioventricular node. Methods: from November 2013 to August 2014, 112 patients with paroxysmal palpitation in our department were examined by endocardial electrophysiological examination, 48 of which were diagnosed as SF-AVNRT. with obvious jumping phenomenon. In the 48 patients, the electrode was placed to the standard position, and then the high right atrium (HRA) was used to stimulate S1S1 500ms stimulation. The Hisl,2 AH interval was measured, that is, the conduction time of atrioventricular node, the jumping point of atrioventricular node was recorded and the jumping value was measured by S1S2 stimulation. This jumping point was used as the effective refractory period (before ERP) for preoperative fast pathway in patients with AVNRT. RV S1S1 500ms stimulation was performed to determine the HA distance between the ends of the His1,2 pole as the retrograde time of atrioventricular node (AVN), and S1S2 stimulation was performed to record the atrioventricular nodal retrograde jump point and to determine the effective refractory period (ERP inverse) of atrioventricular nodal inversion (AVN). Then the patients with slow pathway radiofrequency ablation were routinely ablated by inferior method. The onset of slow nodal rhythm was effective. The end point of the operation was HRA S1S2 stimulation without AH jumping and atrioventricular nodal reentry. The electrode was sent to the standard position before operation. The conduction time of atrioventricular node was measured by HRA S1S1 500ms stimulation (before TFP), and the effective refractory period (before ERPFP) by S1S2 stimulation. The refractory period of atrioventricular node was the effective refractory period of fast pathway. The reverse-transit time of atrioventricular node was measured by RV S1S1500ms stimulation, and the effective refractory period (before ERPFP) was measured by S1S2 stimulation. The conduction time of fast pathway before and after operation was compared, and whether the effective refractory period changed or not. The relationship between the fast and slow pathway of atrioventricular node was inferred based on the results of the study. Results: 1. All the 48 patients were successfully operated without complications. No significant AH jump was found in repeated cardiac electrophysiological examination, nor any tachycardia or atrioventricular nodal reentry was induced. To reach the standard of complete slow pathway ablation, 48 patients were enrolled in the study. The fast path forward conduction time (TFP) was shortened from 106.04- 36.36ms to 89.98-27.09msp0.001. The difference was statistically significant. 3, the effective refractory period of fast path forward conduction (before ERPFP) was shortened from 330.00 鹵53.31ms to 250.21- 鹵56.81msP 0.001, the difference was statistically significant. 4, fast path reverse conduction time (TFP inverse) was shortened from 94.54 28.39ms to 86.62 24.88 Ms P0. 010 after operation. The difference was statistically significant. Conclusion: the fast pathway forward and reverse conduction function were improved after slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia. Slow path and fast path are not independent structures, but interact with each other. The existence of slow path inhibits the conduction of fast path.
【學(xué)位授予單位】：廣西醫(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)】：R541.7
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 袁義強(qiáng),劉懷霖,李靖;房室結(jié)改良術(shù)終點(diǎn)、快徑傳導(dǎo)功能與 復(fù)發(fā)率三者關(guān)系的回顧性研究[J];河南醫(yī)學(xué)研究;1999年04期
2 劉啟功,張存泰,王琳,王晨,陸再英;房室結(jié)折返性心動(dòng)過(guò)速與房室結(jié)雙徑路的相關(guān)性研究[J];臨床心電學(xué)雜志;2000年04期
3 覃紹明;鄧金龍;林英忠;吳隱雄;覃麗萍;;射頻消融慢徑路對(duì)不典型房室結(jié)雙徑路前傳功能的影響[J];陜西醫(yī)學(xué)雜志;2007年12期
4 盧先本;徐耕;唐禮江;江建軍;方崇峰;王斌;傅信;;能量滴定法在慢徑改良術(shù)中預(yù)防房室傳導(dǎo)阻滯的作用研究[J];心腦血管病防治;2007年03期
5 ;射頻導(dǎo)管消融治療快速心律失常指南(修訂版)[J];中國(guó)心臟起搏與心電生理雜志;2002年02期
6 郭煒華;房室結(jié)雙徑路與房室結(jié)折返性心動(dòng)過(guò)速的研究概況[J];中國(guó)心臟起搏與心電生理雜志;2004年01期
7 王祖祿,陳新;Jackman教授訪華講座紀(jì)要[J];中華心律失常學(xué)雜志;2002年02期
8 馬堅(jiān),楚建民,張澍,魯志民;二尖瓣環(huán)后間隔部位射頻消融房室結(jié)慢徑路一例[J];中華心律失常學(xué)雜志;2002年03期
9 楊新春,葛永貴,商麗華,胡大一;射頻消融房室結(jié)慢徑對(duì)快徑傳導(dǎo)功能的影響(摘要)[J];中華心血管病雜志;1997年02期
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本文編號(hào)：2415303
本文鏈接：http://sikaile.net/yixuelunwen/xxg/2415303.html
[Abstract]:Objective: the purpose of this study was to increase the research angle of retrograde transmission after slow pathway ablation in patients with AVNRT by strictly controlling the research conditions and innovating the observation indexes on the basis of previous studies. To investigate the changes of fast pathway conduction function after slow pathway ablation in patients with slow fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), and to speculate the relationship between atrioventricular nodal fast pathway and slow pathway by observing the changes of fast path conduction function after slow pathway ablation. It provides reliable electrophysiological basis for further study on the exact structure of atrioventricular node. Methods: from November 2013 to August 2014, 112 patients with paroxysmal palpitation in our department were examined by endocardial electrophysiological examination, 48 of which were diagnosed as SF-AVNRT. with obvious jumping phenomenon. In the 48 patients, the electrode was placed to the standard position, and then the high right atrium (HRA) was used to stimulate S1S1 500ms stimulation. The Hisl,2 AH interval was measured, that is, the conduction time of atrioventricular node, the jumping point of atrioventricular node was recorded and the jumping value was measured by S1S2 stimulation. This jumping point was used as the effective refractory period (before ERP) for preoperative fast pathway in patients with AVNRT. RV S1S1 500ms stimulation was performed to determine the HA distance between the ends of the His1,2 pole as the retrograde time of atrioventricular node (AVN), and S1S2 stimulation was performed to record the atrioventricular nodal retrograde jump point and to determine the effective refractory period (ERP inverse) of atrioventricular nodal inversion (AVN). Then the patients with slow pathway radiofrequency ablation were routinely ablated by inferior method. The onset of slow nodal rhythm was effective. The end point of the operation was HRA S1S2 stimulation without AH jumping and atrioventricular nodal reentry. The electrode was sent to the standard position before operation. The conduction time of atrioventricular node was measured by HRA S1S1 500ms stimulation (before TFP), and the effective refractory period (before ERPFP) by S1S2 stimulation. The refractory period of atrioventricular node was the effective refractory period of fast pathway. The reverse-transit time of atrioventricular node was measured by RV S1S1500ms stimulation, and the effective refractory period (before ERPFP) was measured by S1S2 stimulation. The conduction time of fast pathway before and after operation was compared, and whether the effective refractory period changed or not. The relationship between the fast and slow pathway of atrioventricular node was inferred based on the results of the study. Results: 1. All the 48 patients were successfully operated without complications. No significant AH jump was found in repeated cardiac electrophysiological examination, nor any tachycardia or atrioventricular nodal reentry was induced. To reach the standard of complete slow pathway ablation, 48 patients were enrolled in the study. The fast path forward conduction time (TFP) was shortened from 106.04- 36.36ms to 89.98-27.09msp0.001. The difference was statistically significant. 3, the effective refractory period of fast path forward conduction (before ERPFP) was shortened from 330.00 鹵53.31ms to 250.21- 鹵56.81msP 0.001, the difference was statistically significant. 4, fast path reverse conduction time (TFP inverse) was shortened from 94.54 28.39ms to 86.62 24.88 Ms P0. 010 after operation. The difference was statistically significant. Conclusion: the fast pathway forward and reverse conduction function were improved after slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia. Slow path and fast path are not independent structures, but interact with each other. The existence of slow path inhibits the conduction of fast path.
【學(xué)位授予單位】：廣西醫(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)】：R541.7
【參考文獻(xiàn)】
相關(guān)期刊論文 前9條
1 袁義強(qiáng),劉懷霖,李靖;房室結(jié)改良術(shù)終點(diǎn)、快徑傳導(dǎo)功能與 復(fù)發(fā)率三者關(guān)系的回顧性研究[J];河南醫(yī)學(xué)研究;1999年04期
2 劉啟功,張存泰,王琳,王晨,陸再英;房室結(jié)折返性心動(dòng)過(guò)速與房室結(jié)雙徑路的相關(guān)性研究[J];臨床心電學(xué)雜志;2000年04期
3 覃紹明;鄧金龍;林英忠;吳隱雄;覃麗萍;;射頻消融慢徑路對(duì)不典型房室結(jié)雙徑路前傳功能的影響[J];陜西醫(yī)學(xué)雜志;2007年12期
4 盧先本;徐耕;唐禮江;江建軍;方崇峰;王斌;傅信;;能量滴定法在慢徑改良術(shù)中預(yù)防房室傳導(dǎo)阻滯的作用研究[J];心腦血管病防治;2007年03期
5 ;射頻導(dǎo)管消融治療快速心律失常指南(修訂版)[J];中國(guó)心臟起搏與心電生理雜志;2002年02期
6 郭煒華;房室結(jié)雙徑路與房室結(jié)折返性心動(dòng)過(guò)速的研究概況[J];中國(guó)心臟起搏與心電生理雜志;2004年01期
7 王祖祿,陳新;Jackman教授訪華講座紀(jì)要[J];中華心律失常學(xué)雜志;2002年02期
8 馬堅(jiān),楚建民,張澍,魯志民;二尖瓣環(huán)后間隔部位射頻消融房室結(jié)慢徑路一例[J];中華心律失常學(xué)雜志;2002年03期
9 楊新春,葛永貴,商麗華,胡大一;射頻消融房室結(jié)慢徑對(duì)快徑傳導(dǎo)功能的影響(摘要)[J];中華心血管病雜志;1997年02期
，本文編號(hào)：2415303
本文鏈接：http://sikaile.net/yixuelunwen/xxg/2415303.html
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