導(dǎo)管射頻消融治療對(duì)陣發(fā)性房顫患者左房?jī)?nèi)徑及近期預(yù)后的影響
發(fā)布時(shí)間：2019-05-12 06:39
【摘要】：目的:陣發(fā)性房顫(PAF)反復(fù)發(fā)作,導(dǎo)致左心房擴(kuò)大,心臟泵血功能減低,心房?jī)?nèi)附壁血栓形成,甚至心力衰竭、栓塞等嚴(yán)重并發(fā)癥,危及患者生命健康。本研究通過(guò)比較導(dǎo)管射頻消融術(shù)(RFCA)與藥物保守治療對(duì)陣發(fā)性房顫患者左房?jī)?nèi)徑及近期預(yù)后的影響,評(píng)價(jià)導(dǎo)管射頻消融對(duì)PAF患者治療的安全性與有效性。方法:入選56例陣發(fā)性房顫患者,根據(jù)患者及家屬意愿,分成兩組,射頻消融組32例,藥物治療組24例。院外隨訪1年,記錄房顫復(fù)發(fā)、患者再入院率、血栓栓塞事件等相關(guān)并發(fā)癥的發(fā)生,并行超聲心動(dòng)圖檢測(cè)患者左心房?jī)?nèi)徑(LAD)、右心房?jī)?nèi)徑(RAD)、左心室內(nèi)徑(LVD)、右心室內(nèi)徑(RVD)、左室后壁厚度(LVPW)、左心室射血分?jǐn)?shù)(LVEF)指標(biāo)與治療前相對(duì)比,比較兩種治療方法對(duì)患者左心房?jī)?nèi)徑及近期預(yù)后的影響。所有數(shù)據(jù)均采用SPSS 21軟件包進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料用率或百分比表示。采用獨(dú)立樣本t檢驗(yàn)或配對(duì)t檢驗(yàn)對(duì)數(shù)據(jù)進(jìn)行分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1兩組患者的基線情況兩組在年齡、性別、身高、體重、房顫病史、合并高血壓比例、合并糖尿病比例、LAD、RAD、LVD、RVD、LVPW、LVEF方面差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)2兩組患者治療1年后與治療前超聲心動(dòng)圖各指標(biāo)的比較2.1射頻消融組治療前后超聲心動(dòng)圖各項(xiàng)指標(biāo)的比較術(shù)后1年 LAD 較術(shù)前顯著縮小(35.13±3.66mmvs 37.03±4.43mm,P=0.000),提示陣發(fā)性房顫患者行射頻消融治療1年后左心房?jī)?nèi)徑減小。術(shù)后1年與術(shù)前相比,RAD、LVD、RVD、LVPW、LVEF差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.2藥物治療組治療前后超聲心動(dòng)圖各項(xiàng)指標(biāo)的比較治療1年后LAD較治療前顯著擴(kuò)大(39.79±3.97mm vs 37.92 ±3.92mm,P=0.000);LVD較治療前顯著擴(kuò)大(49.38±5.20mm vs 47.33±5.26mm,P=0.023)。提示陣發(fā)性房顫患者藥物治療1年后左心房、左心室內(nèi)徑增大。治療1年后,RAD、RVD、LVPW、LVEF較治療前無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3兩組患者治療1年后超聲心動(dòng)圖各項(xiàng)指標(biāo)的比較治療1年后射頻消融組與藥物治療組相比,LAD顯著縮小(35.13±3.66mm vs 39.79±3.97mm,P=0.000);LVEF顯著提高(65.58±5.71%vs 61.78±6.88%,P=0.028)。提示對(duì)于陣發(fā)性房顫患者,導(dǎo)管射頻消融較藥物保守治療可縮小左心房?jī)?nèi)徑,提高左室射血分?jǐn)?shù)。射頻消融組與藥物治療組相對(duì)比,RAD、LVD、RVD、LVPW差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4兩組患者近期預(yù)后事件發(fā)生觀察4.1射頻消融組32例患者均順利完成手術(shù),有1例患者術(shù)后出現(xiàn)少量心包積液。經(jīng)1年的隨訪,維持竇性心律者30例(93.75%)。2例患者房顫復(fù)發(fā),其中1例為無(wú)癥狀性房顫復(fù)發(fā);另1例患者因癥狀不耐受再次入院。均無(wú)心力衰竭、血栓栓塞事件發(fā)生。4.2藥物治療組經(jīng)1年的隨訪,24例患者中維持竇性心律者15例(62.5%)。9例患者中,4例因房顫復(fù)發(fā)癥狀不耐受再次入院,其中1例出現(xiàn)急性左心衰,1例出現(xiàn)新發(fā)腦梗塞;2例進(jìn)展為持續(xù)性房顫;3例仍為陣發(fā)性房顫。結(jié)論:與單純藥物治療相比,導(dǎo)管射頻消融可降低陣發(fā)性房顫的復(fù)發(fā)率,縮小左心房?jī)?nèi)徑,改善患者近期預(yù)后,提高患者生活質(zhì)量。
[Abstract]:Objective: The repeated episodes of paroxysmal atrial fibrillation (PAF), which lead to the enlargement of the left atrium, the reduction of the blood function of the heart pump, the formation of mural thrombus in the atria, and even the serious complications such as heart failure and embolism, endanger the life and health of the patients. The purpose of this study was to evaluate the effect of catheter radiofrequency ablation (RFCA) and conservative treatment on the inner diameter of left atrial and the near-term prognosis of patients with paroxysmal atrial fibrillation, and to evaluate the safety and effectiveness of catheter RF ablation on the treatment of PAF. Methods:56 patients with paroxysmal atrial fibrillation were divided into two groups according to the wishes of the patient and the family. The patients were followed up for 1 year to record the occurrence of related complications such as the recurrence of AF, the readmission rate of the patient and the event of thromboembolic events. The left atrial diameter (LAD), the right atrial diameter (RAD), the left ventricular inner diameter (LVD), and the right ventricular internal diameter (RVD) of the patient were detected by the parallel echocardiography. The left ventricular posterior wall thickness (LVPW), the left ventricular ejection fraction (LVEF) index and the pre-treatment relative ratio were compared, and the effect of the two treatment methods on the left atrial diameter and the near-term prognosis of the patient was compared. All data were analyzed by SPSS 21 software package. The measurement data is represented by a mean square standard deviation, a count data rate, or a percentage. The data is analyzed using an independent sample t-test or a paired t-test. The difference of P0.05 was of statistical significance. Results: There were two groups of patients with baseline in age, gender, height, body weight, history of atrial fibrillation, combined hypertension, combined type of diabetes, LAD, RAD, LVD, RVD, and LVPW. There was no significant difference in LVEF (P0.05). There was no significant difference in LVEF between the two groups (P <0.05). The comparison of the two groups after 1 year and before and after treatment was significantly reduced in 1 year after the operation (35.13, 3.66 mm vs. 37.03, 4.43 mm, P = 0.000). It was suggested that the left atrial diameter of patients with paroxysmal atrial fibrillation after 1 year was reduced. There was no significant difference in RAD, LVD, RVD, LVPW and LVEF between 1 year and 1 year after operation (P0.05). LVD was significantly enlarged prior to treatment (49.38-5.20 mm vs 47.33-5.26 mm, P = 0.023). It was suggested that the internal diameter of left atrium and left ventricle of patients with paroxysmal atrial fibrillation after 1 year were increased. After 1 year of treatment, there was no significant difference in RAD, RVD, LVPW and LVEF (P0.05). The LVEF was significantly increased (65.58% 5.71% vs 61.78% 6.88%, P = 0.028). It is suggested that for patients with paroxysmal atrial fibrillation, the radiofrequency ablation of the catheter can reduce the inner diameter of the left atrium and increase the left ventricular ejection fraction. There was no significant difference in the relative ratio, RAD, LVD, RVD and LVPW in the radio-frequency ablation group (P0.05). After 1 year of follow-up,30 cases (93.75%) of the patients with atrial fibrillation were maintained. The recurrence of AF in 2 patients, one of which was asymptomatic AF, and the other was admitted to the hospital again due to the symptoms. There were no cases of heart failure and thromboembolic events. The 1-year follow-up of the drug-treated group and 15 (62.5%) of the 24 patients with cardiac rhythm in 24 patients (62.5%). Among the 9 patients,4 of the 9 patients were admitted to the hospital again due to the recurrent symptoms of AF, one of which had acute left heart failure and one with new cerebral infarction; 2 cases progressed to persistent AF;3 were still paroxysmal atrial fibrillation. Conclusion: Compared with pure drug therapy, radiofrequency ablation of catheter can reduce the recurrence rate of paroxysmal atrial fibrillation, narrow the inner diameter of the left atrium, improve the recent prognosis of patients and improve the quality of life of patients.
【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】：2017
【分類號(hào)】：R541.75
本文編號(hào)：2475184
[Abstract]:Objective: The repeated episodes of paroxysmal atrial fibrillation (PAF), which lead to the enlargement of the left atrium, the reduction of the blood function of the heart pump, the formation of mural thrombus in the atria, and even the serious complications such as heart failure and embolism, endanger the life and health of the patients. The purpose of this study was to evaluate the effect of catheter radiofrequency ablation (RFCA) and conservative treatment on the inner diameter of left atrial and the near-term prognosis of patients with paroxysmal atrial fibrillation, and to evaluate the safety and effectiveness of catheter RF ablation on the treatment of PAF. Methods:56 patients with paroxysmal atrial fibrillation were divided into two groups according to the wishes of the patient and the family. The patients were followed up for 1 year to record the occurrence of related complications such as the recurrence of AF, the readmission rate of the patient and the event of thromboembolic events. The left atrial diameter (LAD), the right atrial diameter (RAD), the left ventricular inner diameter (LVD), and the right ventricular internal diameter (RVD) of the patient were detected by the parallel echocardiography. The left ventricular posterior wall thickness (LVPW), the left ventricular ejection fraction (LVEF) index and the pre-treatment relative ratio were compared, and the effect of the two treatment methods on the left atrial diameter and the near-term prognosis of the patient was compared. All data were analyzed by SPSS 21 software package. The measurement data is represented by a mean square standard deviation, a count data rate, or a percentage. The data is analyzed using an independent sample t-test or a paired t-test. The difference of P0.05 was of statistical significance. Results: There were two groups of patients with baseline in age, gender, height, body weight, history of atrial fibrillation, combined hypertension, combined type of diabetes, LAD, RAD, LVD, RVD, and LVPW. There was no significant difference in LVEF (P0.05). There was no significant difference in LVEF between the two groups (P <0.05). The comparison of the two groups after 1 year and before and after treatment was significantly reduced in 1 year after the operation (35.13, 3.66 mm vs. 37.03, 4.43 mm, P = 0.000). It was suggested that the left atrial diameter of patients with paroxysmal atrial fibrillation after 1 year was reduced. There was no significant difference in RAD, LVD, RVD, LVPW and LVEF between 1 year and 1 year after operation (P0.05). LVD was significantly enlarged prior to treatment (49.38-5.20 mm vs 47.33-5.26 mm, P = 0.023). It was suggested that the internal diameter of left atrium and left ventricle of patients with paroxysmal atrial fibrillation after 1 year were increased. After 1 year of treatment, there was no significant difference in RAD, RVD, LVPW and LVEF (P0.05). The LVEF was significantly increased (65.58% 5.71% vs 61.78% 6.88%, P = 0.028). It is suggested that for patients with paroxysmal atrial fibrillation, the radiofrequency ablation of the catheter can reduce the inner diameter of the left atrium and increase the left ventricular ejection fraction. There was no significant difference in the relative ratio, RAD, LVD, RVD and LVPW in the radio-frequency ablation group (P0.05). After 1 year of follow-up,30 cases (93.75%) of the patients with atrial fibrillation were maintained. The recurrence of AF in 2 patients, one of which was asymptomatic AF, and the other was admitted to the hospital again due to the symptoms. There were no cases of heart failure and thromboembolic events. The 1-year follow-up of the drug-treated group and 15 (62.5%) of the 24 patients with cardiac rhythm in 24 patients (62.5%). Among the 9 patients,4 of the 9 patients were admitted to the hospital again due to the recurrent symptoms of AF, one of which had acute left heart failure and one with new cerebral infarction; 2 cases progressed to persistent AF;3 were still paroxysmal atrial fibrillation. Conclusion: Compared with pure drug therapy, radiofrequency ablation of catheter can reduce the recurrence rate of paroxysmal atrial fibrillation, narrow the inner diameter of the left atrium, improve the recent prognosis of patients and improve the quality of life of patients.
【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】：2017
【分類號(hào)】：R541.75
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