1、二尖瓣脱垂与室性早搏 2、减肥手术对肥胖患者长期心房颤动发生的影响

发布时间：2018-04-24 22:09

本文选题：抗心律失常药物 + 二尖瓣脱垂　；参考：《中国人民解放军医学院》2015年博士论文

【摘要】：第一部分二尖瓣脱垂与室性早搏背景与目的二尖瓣脱垂患者中室性早搏的特点以及对治疗的反应目前还不是特别清楚,尤其是与没有二尖瓣脱垂的患者相比较,仍需要进一步的研究。本研究目的为分析伴有或不伴有二尖瓣脱垂的患者中室性早搏的特点,同时评价药物治疗和射频消融治疗在两组中疗效的差异。方法将2001年1月至2012年10月之间记录的有室性早搏的患者分为两组:二尖瓣脱垂组和非二尖瓣脱垂组。将两组间室性早搏特点、治疗效果以及预后作对照分析。结果共入组了 1964名患者,其中二尖瓣脱垂组112名,非二尖瓣脱垂组952名。两组间室性早搏发生频率未见明显差异(P.05)。相对于非二尖瓣脱垂组来说,起源于乳头肌(26.7% vs 2.3%; P.001)和束支(13.3% vs 3.4%; P.001)的室性早搏多见于二尖瓣脱垂患者。两组对于药物治疗或射频消融治疗的反应无明显差异(P.05)。两组总体生存率大致相似(P=.95)。结论二尖瓣脱垂患者与非二尖瓣脱垂患者拥有相似的室性早搏频率、室早治疗反应和生存率。第二部分减肥手术对肥胖患者长期心房颤动发生的影响背景与目的肥胖已经被证实为房颤发生的独立危险因素,随着体重增加,房颤发生风险也明显增加。目前肥胖治疗手段除了生活方式改变、运动、饮食调节、药物之外,外科手术减肥已成为有效的措施。而减肥手术在减轻体重的同时是否也降低了患者新发房颤的风险目前尚不清楚。本研究目的为证明Roux-en-Y胃肠旁路手术(RYGB)是否会降低Ⅱ型及Ⅲ型肥胖患者新发心房颤动的风险。方法我们进行一项回顾性队列研究,入选了明尼苏达州奥姆斯特县1993年1月至2012年12月之间明确为Ⅱ型和Ⅲ型肥胖患者。从诊断为肥胖开始随访,确定每一例新发的心房颤动,应用Cox比例风险模型分析是否RYGB减肥手术能有效预防心房颤动的发生。结果研究共入选了 1018名肥胖患者,其中550名接受了减肥手术。总体研究人群中797名(78%)患者为女性,平均年龄为42.3 (6.9)岁。平均体重指数(body mass index, BMI)为45.4 (6.9) kg/m2。手术组中,患者体重指数、收缩压、血糖、糖化血红蛋白、甘油三酯水平均显著下降(all P.001),而非手术组患者上述指标无明显变化,有的甚至恶化。从第一次诊断肥胖(BMI≥35kg/m2)开始,经过平均11.3 (4.2)年的随访,48名患者(13名手术组患者,35名非手术组患者)出现新发心房颤动。经过性别和年龄校正后,减肥手术并未证实为预防心房颤动发生的独立影响因素(风险比0.81 [95% CI, 0.41-1.60];P=.35)。结论尽管减肥手术可明显降低体重指数,手术患者较对照组有较低的新发房颤发生率,但减肥手术并未证明是减少新发房颤的独立预测因素。
[Abstract]:The first part is the characteristics of the ventricular premature beats in patients with mitral valve prolapse and ventricular premature beats, and the response to the treatment is not particularly clear, especially in comparison with those without mitral prolapse. The characteristics of ventricular premature beats in the two groups were also evaluated. Methods the patients with ventricular premature beat recorded between January 2001 and October 2012 were divided into two groups: the mitral valve prolapse group and the non mitral valve prolapse group. The characteristics of the ventricular premature beat, the treatment effect and the prognosis were compared between the two groups. Results there were 1964 patients in the group, including 112 patients in the mitral prolapse group and 952 non mitral prolapse groups. There was no significant difference in the frequency of ventricular premature beat between the two groups (P.05). Compared with non mitral valve prolapse, the ventricular premature beat originated from the papillary muscle (26.7% vs 2.3%; P.001) and the bundle branch (13.3% vs 3.4%; P.001). There was no significant difference between the two groups (P.05). The total survival rate in the two groups was roughly similar (P=.95). Conclusion the patients with mitral prolapse and non mitral prolapse have similar ventricular premature beat frequency, early ventricular response and survival rate. Second partial weight loss surgery for long-term atrium of obese patients. Obesity has been proved to be an independent risk factor for atrial fibrillation. With the increase of weight, the risk of atrial fibrillation is also significantly increased. Obesity treatment has become an effective measure in addition to lifestyle changes, exercise, diet regulation, and medications. The purpose of this study is to demonstrate whether Roux-en-Y gastrointestinal bypass surgery (RYGB) may reduce the risk of new onset atrial fibrillation in type II and type III obese patients. Methods we conducted a retrospective cohort study and was selected for January 1993 in Homs County, Minnesota. From December 2012 to December 2012, the patients with type II and type III obesity were followed up from the diagnosis of obesity to determine each new onset of atrial fibrillation. The Cox proportional hazard model was used to analyze whether the RYGB diet could effectively prevent atrial fibrillation. Results a total of 1018 obese patients were enrolled in the study, of which 550 were treated with a weight loss operation. In the overall study, 797 (78%) patients were women with an average age of 42.3 (6.9) years. The average body mass index (body mass index, BMI) was 45.4 (6.9) kg/m2. operation group. The patients' body mass index, systolic blood pressure, blood sugar, glycated hemoglobin, triglyceride level were significantly decreased (all P.001), but there was no significant change in the above indexes in the non operative group. Some even worsened. From the first diagnosis of obesity (BMI > 35kg/m2), after an average of 11.3 (4.2) years of follow-up, 48 patients (13 surgical patients, 35 non operative patients) had new atrial fibrillation. After gender and age correction, weight loss surgery did not prove to be an independent factor in the prevention of atrial fibrillation (risk ratio 0.81). [95% CI, 0.41-1.60]; P=.35). Conclusion although the BMI can significantly reduce body mass index, patients with surgery have a lower incidence of new atrial fibrillation than the control group, but weight loss surgery does not prove to be an independent predictor of the reduction of new atrial fibrillation.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R542.5

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