压力监测导管在心房颤动导管消融术中应用的初步观察

发布时间：2018-03-21 04:06

  本文选题：心房颤动　切入点：导管消融术　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察压力监测导管在心房颤动导管消融术中的应用效果方法:研究对象为2015年5月~2016年5月期间皖南医学院附属弋矶山医院心血管内科收治的59例行导管消融术的心房颤动(atrial fibrillation,AF)患者,使用随机数字法将纳入患者分为两组。使用压力监测导管(SmartTouch,ST)消融的作为ST消融组,共32例,其中阵发性房颤29例,持续性房颤3例;使用普通盐水灌注导管消融的作为常规消融组,共27例,其中阵发性房颤25例,持续性房颤2例。导管消融术后随访6~12个月,将ST消融组患者的手术时间、消融放电时间、X线曝光时间、X线曝光量、肺静脉单圈隔离率、消融补点个数、并发症的发生率及随访期间的复发率与常规消融组之间进行比较。结果:常规消融组与ST消融组在性别、年龄、体重指数、房颤病程、房颤类型、合并症、左房舒张末期内径(LAEDD)、左室射血分数(LVEF)方面,差异无统计学意义(P0.05);ST消融组患者的手术时间、消融放电时间、X线曝光时间以及X线曝光量,均低于常规消融组,差异有统计学意义(128.0±23.4VS168.4±24.0;51.3±12.1VS80.6±19.8;14.2±3.6VS23.5±5.9;230.1±51.0VS315.0±69.0,P0.05);ST消融组患者的左肺静脉单圈隔离率、右肺静脉单圈隔离率高于常规消融组;左肺静脉补点个数以及右肺静脉补点个数低于常规消融组,差异有统计学意义(80.0%VS55.6%;85.0%VS59.3%;1.3±0.6VS2.8±1.5;0.8±0.4VS1.5±0.7,P0.05);ST消融组在导管消融术后出现皮下血肿的患者共有2例;常规消融组共有7例患者在导管消融术中及术后出现手术并发症,其中有4例患者并发皮下血肿,1例患者并发食道水肿,2例患者并发心包填塞,经过内科积极保守治疗后均治愈出院。采用Fisher确切概率法检验得出ST消融组患者的手术相关并发症的发生率低于常规消融组,但差异无统计学意义(6.3%VS25.9%,P0.05)。在随访期内,发作持续时间≥30s的快速性房性心律失常的患者,在ST消融组共有3例,常规消融组共有8例,其中5位患者行二次导管消融手术,3位患者予以抗心律失常药物保守治疗。将所得数据进行卡方检验得出,ST消融组患者导管消融术后的手术复发率低于常规消融组,差异有统计学意义(9.4%VS29.6%,P0.05)。结论:在房颤导管消融术中使用压力监测导管可以帮助术者更好的掌控导管与心肌组织之间的贴靠力度,提高肺静脉单圈隔离成功率及减少消融补点个数,从而有效的缩短手术时间、消融放电时间、X线曝光时间以及减少X线曝光量,也可以有效的降低房颤导管消融术后的复发率,因此具有较高的临床应用价值。
[Abstract]:Objective: to observe the effect of pressure monitoring catheter in atrial fibrillation catheter ablation. Methods: 59 cases of catheterization in the Department of Cardiovascular Medicine affiliated to the Southern Anhui Medical College from May 2015 to May 2016 were studied. Patients with atrial fibrillation after ablation, The patients were divided into two groups by random digital method. 32 patients were treated with pressure monitoring catheter SmartTouchus ST-ablation group, 29 patients with paroxysmal atrial fibrillation and 3 patients with persistent atrial fibrillation. A total of 27 patients, including 25 patients with paroxysmal atrial fibrillation and 2 patients with persistent atrial fibrillation, were treated with common brine perfusion catheter ablation. The patients were followed up for 6 to 12 months after catheter ablation, and the operative time of St ablation group was compared. The time of ablation discharge and the time of X-ray exposure, the isolation rate of pulmonary vein in single circle, the number of ablation points, Results: sex, age, body mass index, duration of atrial fibrillation, type of atrial fibrillation, complications were compared between conventional ablation group and St ablation group. There was no significant difference in left atrial end-diastolic diameter and left ventricular ejection fraction (LVEF) in patients with St ablation, such as operation time, ablation discharge time, X-ray exposure time and X-ray exposure, which were lower than those in the conventional ablation group, and there was no significant difference in left atrial end diastolic diameter and left ventricular ejection fraction (LVEF). The difference was statistically significant (128.0 卤23.4VS168.4 卤24.0VS81.3 卤12.1VS80.6 卤19.8VS23.5 卤5.9230.1 卤51.0VS315.0 卤69.0VS315.0 卤69.0VS0.05 + St ablation group), the isolation rate of right pulmonary vein was higher than that of conventional ablation group, the number of right pulmonary vein complement points and the number of left pulmonary vein complement points were lower than that of conventional ablation group. There were significant differences between the two patients with subcutaneous hematoma after catheter ablation in the St ablation group (1.3 卤0.6VS2.8 卤1.5VS2.8 卤1.5VS0.8 卤0.4VS1.5 卤0.7VS0.05) and the routine ablation group (7 patients with postoperative complications during and after catheter ablation). Among them, 4 cases were complicated with subcutaneous hematoma, 1 case with oesophagus edema and 2 cases with pericardial tamponade. The incidence of surgical complications in St ablation group was lower than that in conventional ablation group, but the difference was not statistically significant (P 0.05). There were 3 cases in St ablation group and 8 cases in routine ablation group in patients with atrial tachyarrhythmia with duration 鈮，

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