室性早搏特点对频发室早患者左心功能及结构的影响

发布时间：2018-04-20 04:07

  本文选题：室性早搏 + 左心室功能　； 参考：《大连医科大学》2017年硕士论文

【摘要】：背景:室性早搏(Premature Ventricular Contractions,PVC)是临床上较常见的心律失常。最初特发性室早被认为是单纯的"良性"表现,死亡风险与一般人群无显著差异,但是近年来许多研究发现,无潜在器质性心脏病的PVC患者随着PVC的发生与发展,会发生心室的可逆性重构,并逐渐出现左室功能受损等变化,甚至发生室性早搏性心肌病。寻找PVC对心脏功能及结构的影响因素,从而探寻室性早搏性心肌病发生机制,成为目前研究的热点之一。目的:分析室性早搏(Premature Ventricular Contractions,PVC)患者的性别、年龄、PVC病史时间、PVC负荷、PVC频率的小时变异系数及四分位变异系数、QRS波时限、起源部位、联律间期、有无非持续性室速等因素对左心功能、结构的影响,为临床PVC的诊疗及预后提供参考。方法:回顾性分析2015年5月至2016年11月期间于大连医科大学附属第一医院心律失常科住院,并诊断为PVC的患者,排除其他非室性心律失常疾病及已被诊断为器质性心脏病患者。筛选出符合条件的患者共197例,根据患者左室射血分数(Left Ventricular Ejection Fraction,LVEF)有无下降及左室内径(Left Ventricular End-diastolic internal Diameter,LVED)有无增宽,分组对照各组间性别、年龄,PVC的QRS波时限、负荷、频率变异系数等的差异,分析各因素对左心功能及结构的影响。应用统计软件SPSS 21.0进行数据分析。结果:(1)各组间基线资料如年龄、性别,PVC病史时间,PVC的联律间期、有无逆P'、有无间位PVC,有无非持续性室速,E/A均无明显统计学差异(P0.05)。(2)与相对应的正常组的PVC负荷比较,LVEF下降组(25.31±11.01%vs.13.70±8.39%,P0.001)及 LVED 升高组(24.86± 11.46%vs.15.35±9.64%,P0.001)均偏高。PVC 负荷升高时,LVEF 降低(58.18±2.51%vs.56.27±3.00%,P0.001),LVED 升高(46.23±4.30%vs.48.12±4.96%,P=0.008)。(3)比较LVEF下降组、LVED升高组与相对应正常组PVC的QRS波时限,发现前者QRS波时限较长。QRS波时限延长时,LVEF降低(58.19±2.28 vs.56.70± 3.11,P=0.001)。(4)LVEF下降组与正常组相比,小时变异系数(25.8%(20.0%,30.1%)vs.60.7%(46.8%,89.2%),P0.001)及四分位变异系数(15.8%(10.6%,22.5%)vs.44.7%(31.8%,67.7%),P0.001)均偏低,LVED升高组与正常组相比,小时变异系数(28.0%(21.1%,53.9%)vs.53.2%(36.4%,83.4%),P0.001)及四分位变异系数(21.0%(11.3%,33.5%)vs.38.4%(23.3%,63.6%),P0.001)亦偏低。(5)分析PVC起源部位,可见右室流出道(Right Ventricular Outflow Tract,RVOT)起源最多,占60.9%。比较不同PVC起源部位间LVEF、LVED、E/E'、LAV,无统计学差异(P0.05)。(6)按有无非持续性室速进行分组,对比两组间LVEF、LVED、E/E'、LAV,无统计学差异(P0.05)。结论:本研究发现,PVC负荷增大,QRS波时限延长,小时变异系数及四分位变异系数偏低的PVC患者更易出现LVEF下降、LVED升高。提示PVC心电特点对心功能危险分层,及尽早识别有可能出现心脏功能及结构损害的患者有临床意义。
[Abstract]:Background: premature Ventricular PVC is a common arrhythmia. At first, idiopathic ventricular premature was regarded as a simple "benign" manifestation, and the risk of death was not significantly different from that of the general population. However, in recent years, many studies have found that PVC patients without potential organic heart disease develop with the onset and development of PVC. The reversible remodeling of the ventricle may occur, and the left ventricular function will be impaired gradually, and even ventricular premature cardiomyopathy will occur. To find out the influence factors of PVC on cardiac function and structure, and to explore the mechanism of ventricular premature cardiomyopathy (VPCM), has become one of the hot research topics. Objective: to analyze the gender, age and age of premature Ventricular cases (PVCs) patients with ventricular premature beats (VPB), and to analyze the time of variation and quartile variation of PVC loading frequency, the time limit of QRS wave, the origin of PVCs, and the associated rhythm interval. The influence of nonpersistent ventricular tachycardia on left ventricular function and structure provides a reference for the diagnosis, treatment and prognosis of PVC. Methods: from May 2015 to November 2016, the patients who were hospitalized in Arrhythmia Department of the first affiliated Hospital of Dalian Medical University and diagnosed as PVC were excluded from other non-ventricular arrhythmia diseases and had been diagnosed as organic heart disease. A total of 197 eligible patients were selected. According to the decrease of left ventricular ejection fraction (left Ventricular Ejection fraction) and the enlargement of left ventricular diameter (left Ventricular End-diastolic internal internal LVED), there were sex, age, QRS wave duration and load in control group. The influence of various factors on left ventricular function and structure was analyzed. The statistical software SPSS 21. 0 was used to analyze the data. Results (1) baseline data such as age, sex, time of PVC disease history, There was no significant difference in PVC load between the normal group and the normal group (P = 25.31 卤11.01%vs.13.70 卤8.39 vs P 0.001) and the group with elevated LVED (24.86 卤11.46%vs.15.35 卤9.64 P 0.001). All of them were lower than those of the normal group (58.18 卤2.51%vs.56.27 卤3.00 卤3.00 卤P 0.001). (46.23 卤4.30%vs.48.12 卤4.96) the duration of QRS wave in LVEF decreased group was higher than that in normal group, and the duration of QRS wave in PVC group was higher than that in normal group. It was found that when the time limit of the former QRS wave was longer. QRS wave duration was prolonged, the LVEF decreased by 58.19 卤2.28 vs.56.70 卤3.11P0. 001n. P0.001. P0.001. In the group of falling LVEFs, compared with the normal group, the coefficient of variation per hour was 25.80.00 and 30.1vs.60.7m, which was lower than that in the normal group, and the coefficient of variation at the quaternion was 15.810.67.5vs.44.7. the level of LVED was lower in the group with higher LVED than that in the normal group, and there was no significant difference between the two groups. The coefficient of variation of 28.00.21. 1: 53.9v s.53.2) and the coefficient of variation of 21.0% 11.33.35% and 38.4m 23.33.63.63.6P0.001) the origin of PVC was found to be the most common, accounting for 60.9% of the right ventricular outflow tract (right Ventricular Outflow tracts) in the right ventricular outflow tract (RVO), accounting for 66. 9% of the total number of RVOTs in the right ventricular outflow tract, accounting for 66. 9% of the total number of RVOTs in the right ventricular outflow tract, accounting for 66. 9%, and 33. 5% respectively (P 0. 001) (P 0. 001). The results showed that the origin of RVOT was the highest in the right ventricular outflow tract. There was no statistical difference between the two groups according to whether there was nonpersistent ventricular tachycardia, and there was no statistical difference between the two groups (P 0.05). Conclusion: in this study, we found that PVC patients with higher LVEF load and longer QRS wave duration were more likely to have increased LVEF decrease and LVED in patients with lower coefficient of variation and quartile variation. The results suggest that the characteristics of PVC ECG have clinical significance for risk stratification of cardiac function and early identification of patients with possible cardiac function and structure damage.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
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本文编号：1776157