發(fā)布時(shí)間：2019-02-25 16:11

【摘要】：目的：探討主動(dòng)固定電極導(dǎo)線植入右心房低位間隔的有效性；對病態(tài)竇房結(jié)綜合征患者低位房間隔與右心耳起搏后分析心房顫動(dòng)發(fā)生率、比較P波離散度及左心房容積指數(shù),評(píng)價(jià)對阻止新發(fā)心房顫動(dòng)的有效性。方法：選取2013年2月-2014年4月需要植入永久雙腔起搏器的病態(tài)竇房結(jié)綜合征(sick sinus syndrome, SSS)患者66例,分為2組,分別為：低位房間隔(Low atrial septum, LAS)組與右心耳(Right atrial appendage, RAA)組,心房電極隨機(jī)植入RAA(36例)和LAS(30例),比較手術(shù)時(shí)間和X線曝光時(shí)間,術(shù)后隨訪12個(gè)月。取常規(guī)12導(dǎo)聯(lián)體表心電圖中圖形清晰、基線穩(wěn)定的心電圖測量術(shù)后起搏心電圖P波最大時(shí)限和P波最小時(shí)限,計(jì)算出P波離散度(P wave duration, Pd)并進(jìn)行組間比較。最先離開基線的點(diǎn)作為P波起點(diǎn),最后回到基線的點(diǎn)定義為P波終點(diǎn), 由同一個(gè)人測量。術(shù)后1、3、6、12月隨訪。測量RAA起搏和LAS起搏術(shù)后的P波離散度與左心房容積指數(shù)(atrial volume index, LAVI),并觀察心房顫動(dòng)(atrial fibrillation, Af)發(fā)生情況。結(jié)果：(1)兩組患者術(shù)前基線資料對比無統(tǒng)計(jì)學(xué)意義。(2)LAS組手術(shù)時(shí)間、X線曝光時(shí)間(單位：m i n)明顯長于RAA組,差異有統(tǒng)計(jì)學(xué)意義(50.1±4.8 v s 42.9±5.5,P0.01；8.1±1.7 v s 5.3±1.5,P0.01)。(3)LA S組房顫發(fā)生率(3.3%)較RAA(19.4%)組低。(4)術(shù)后1、3、6、12月RAA組P波離散度(單位：ms)較LAS 組的大, 差異有統(tǒng)計(jì)學(xué)意義(40.78±10.72 v s24.10±10.87；42.13±10.97 v s 23.86±10.76；42.53±11.07vs 25.23±10.92；43.91±11.34 vs 25.30±11.41。p0.01)。(5)術(shù)后1月RAA組和LAS組的LAVI(單位：ml/m2)差異無統(tǒng)計(jì)學(xué)意義(23.80±4.98 vs 22.29±4.12,P=0.19),術(shù)后3月、6月、12月RAA組較LAS組的LAVI(單位：ml/m2)大,兩者差異有統(tǒng)計(jì)學(xué)意義(24.01±4.88 vs 21.67±4.13；24.07±5.03 v s21.47±4.36 ； 24.90±5.04 vs 21.22±4.37,P值依次為0.04；0.03；0.01)。結(jié)論：病態(tài)竇房結(jié)綜合征患者接受起搏器治療,LAS起搏優(yōu)于RAA起搏,但其操作稍復(fù)雜。相對于RAA組,術(shù)后LAS組房顫發(fā)生率可能低,P波離散度降低、LAVI減小,LAS組起搏在阻止新發(fā)心房顫動(dòng)方面可能優(yōu)于RAA組。
[Abstract]:Objective: to investigate the effectiveness of active fixed electrode wire implantation into the right atrium inferior septum (RASS). The incidence of atrial fibrillation was analyzed in patients with sick sinus syndrome after low atrial septum pacing and right atrial pacing. P wave dispersion and left atrial volume index were compared to evaluate the effectiveness of preventing new atrial fibrillation. Methods: from February 2013 to April 2014, 66 patients with sick sinoatrial node syndrome (sick sinus syndrome, SSS) who needed permanent double chamber pacemaker were divided into two groups: low atrial septal (Low atrial septum, LAS) group and right atrial auricular (Right atrial appendage, group. In RAA group, RAA (36 cases) and LAS (30 cases) were implanted at random. The operation time and X-ray exposure time were compared. The follow-up was 12 months after operation. P wave maximum duration and P wave minimum time were measured by routine 12 lead electrocardiogram with clear pattern and stable baseline. P wave dispersion (P wave duration, Pd) was calculated and compared among groups. The first point out of the baseline is the starting point of P-wave, and the last point back to the baseline is defined as the end point of P-wave, which is measured by the same person. All patients were followed up 1, 3, 6, 12 months after operation. P wave dispersion and left atrial volume index (atrial volume index, LAVI),) were measured after RAA pacing and LAS pacing. The occurrence of (atrial fibrillation, Af) in atrial fibrillation was observed. Results: (1) there was no significant difference in baseline data between the two groups before operation. (2) the operation time and X-ray exposure time in LAS group were significantly longer than those in RAA group. The difference was statistically significant (50.1 鹵4.8 vs 42.95.5, P 0.01). The incidence of atrial fibrillation in the LAS group (3.3%) was lower than that in the RAA (19.4%) group. (4) the P wave dispersion in the RAA group was higher than that in the LAS group at 1,3,6,12 months after operation (P < 0.01,). (- 3, P < 0.05, P < 0.01, P < 0.01). The difference was statistically significant (40.78 鹵10.72 vs 24.10 鹵10.87); 42.13 鹵10.97 vs 23.86 鹵10.76, 42.53 鹵11.07vs 25.232.92; 43.91 鹵11.34 vs 25.30 鹵11.41.p0.01). (5) there was no significant difference in LAVI (unit: ml/m2) between RAA group and LAS group 1 month after operation (23.80 鹵4.98 vs 22.29 鹵4.12, P = 0.19). 3 months and 6 months after operation, there was no significant difference in LAVI (unit: ml/m2) between RAA group and LAS group. The LAVI (unit: ml/m2) in RAA group was higher than that in LAS group (24.01 鹵4.88 vs 21.67 鹵4.13) in December, and the difference was statistically significant (24.01 鹵4.88 vs, 21.67 鹵4.13). 24.07 鹵5.03 v s 21.47 鹵4.36; 24.90 鹵5.04 vs 21.22 鹵4.37 (P = 0.04). Conclusion: LAS pacing is superior to RAA pacing in the treatment of sick sinoatrial node syndrome, but its operation is a little complicated. Compared with RAA group, the incidence of atrial fibrillation in LAS group was lower, P wave dispersion decreased and LAVI decreased. Pacing in LAS group was better than that in RAA group in preventing new atrial fibrillation.
【學(xué)位授予單位】：安徽醫(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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