SmartTouch压力监测导管在心房颤动射频消融中的应用

发布时间：2018-06-15 13:51

本文选题：心房颤动 + 射频消融　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[背景]心房颤动在临床工作中是最常见的、危害较大的心律失常之一,且随着我国人口老龄化的进展患病率及患病人数逐年攀升;现阶段心房颤动主要的手术治疗措施包括经导管射频消融及冷冻球囊消融;相比于冷冻球囊消融,经导管射频消融治疗在临床应用更加广泛,如何在提高导管消融有效性的同时,降低复发率,保证手术的安全性是心房颤动导管射频消融治疗的难点。压力监测消融导管是新型消融导管,因其具有术中实时监测导管与心肌接触力及其方向的优势,因此,相比于其他传统类型消融导管(如TC导管),理论上可提高心房颤动射频消融治疗的安全性和有效性。将压力监测导管(ST导管)应用于心房颤动射频消融治疗的相关研究已成为现阶段的热点。[目的]将压力监测导管(ST导管)与普通冷盐水灌注导管(TC导管)在心房颤动导管消融治疗中的安全性以及临床疗效等方面进行综合的分析、比较,从而在心房颤动导管射频消融手术中为患者更合理地选择手术材料及制定更加合理的手术方案,以提高心房颤动导管射频消融的近期及远期成功率,减少术后复发的概率,并提高心房颤动导管消融的安全性,降低术中、术后并发症发生率。[方法]随机选取玉溪市人民医院2014年01月至2016年5月间收治的阵发性房颤(Paroxysmal atrial fibrillation,PAF)以及左心房直径(left atrial diameter,LAD)小于 40mm、病程小于 1 年的持续性房颤(persistent atrial fibrillation,PeAF)行压力监测导管射频消融治疗的患者共计34例,设为研究组。随机抽取同期于玉溪市人民医院接受普通冷盐水灌注NaviStar导管消融治疗的阵发性房颤患者以及病史LAD小于40mm、病程小于1年的持续性房颤患者34例,设为对照组。对照组与研究组男性各有28例、22例,共计50例,女性分别有6例、12例,共计18例,两组共计68例患者。对照组平均年龄59. 50± 11. 58岁,研究组平均年龄58.62±10.67岁,本研究患者年龄在28～77岁范围内,总体平均年龄58. 8± 11. 1岁;对照组及研究组分别有25例及24例PAF,合计51例,对照组及研究组分别有9例及8例PeAF,合计17例。对照组病例的平均射血分数62. 35±4.62%,研究组病例的平均射血分数61. 29±4. 68%;对照组病例持续性房颤患者的平均持续时间7. 50±1. 85月,研究组病例的持续性房颤患者的平均持续时间6. 22±1. 39月。对照组左房内径平均为31. 87±3. 76mm,研究组的平均为31. 52±4. 15mm。两组间性别构成、年龄、房颤病程、房颤类型构成、左室射血分数、左心房内径等基线资料差异无明显统计学意义(P0. 05)。入组病例均为阵发性房颤或者心房重构不显著且病史不长的持续性房颤,所以本研究消融策略为仅行双侧环肺静脉前庭隔离(pulmonary vein isolation,PVI),如果肺静脉隔离完成之后仍未转复为窦性心律者,给予体外同步直流电复律(100J-200J)或静脉注射伊布利特(lmg)转律。极少数持续性房颤患者转律治疗后仍不能维持窦性心律,仍反复发作心房颤动、心房扑动的患者,则视情况加行左房顶部径线、二尖瓣峡部径线、左房前壁径线、三尖瓣峡部径线线性消融,以及必要的碎裂电位消融(complex fractionated atrial electrograms,CFAEs)。本研究观察指标是比较两组患者在手术时间、消融时间、X线曝光时间、X线曝光量、左房建模及肺静脉定口时间、并发症发生率的统计学差异,术后随访3、6、12月比较两组患者术后窦性心律维持率,为房颤患者导管消融治疗时在手术器械选择及手术方案制定方面提供可靠参考。[结果]1.所有入选患者手术均成功进行,术中均转为窦性心律,并能长时间维持。2.所有患者手术过程中未出现蒸汽爆破、急性心包填塞、脑梗死、肺栓塞、死亡等严重手术并发症。3.术后无患者失访,所有入组患者均完成术后3月、术后6月及术后12月的随访。4.相关观察指标:研究组与对照组相比:4.1术后3月、6月随访,窦性心律维持率的差异两组无统计学意义,分别为(94.1% vs.91.2%, P=0.642) (88. 23% vs.76. 5%, P=0.203)。术后 12 月随访:对照组有13例,研究组中有4例复发,两组窦性心律维持率情况差异有统计学意义(88. 23%vs.61. 7%, P0.05)。4.2手术时间研究组明显短于对照组,两组比较差异有统计学意义( 154. 85±28. 62minvs.165.88±22.17min,P0.05)。4. 3环肺静脉消融时间研究组明显短于对照组,两组比较差异有统计学意义(89.71±20.41 minvs.101.62±16.82min,P0.05)。4.4左房建模及肺静脉定口时间研究组明显短于对照组,两组比较差异有统计学意义(8.29±2. 22 min vs.10. 65±2. 58 min,P0.05)。4.5 X射线曝光时间研究组明显少于对照组,且其差异有统计学意义(28. 35±5. 34min vs.39. 38±6.15min) 。4.6 X线曝光量研究组明显低于对照组,两组比较差异有统计学意义(417. 44±80. 45mGy vs.585.68±95.39mGy,P0. 05)。4. 7研究组发生3例并发症,对照组中2例并发症(8. 8% vs.5. 9%,P=0. 16)。[结论]本研究成果显示,与TC导管相比,使用ST导管进行房颤导管消融手术能缩短整体手术时间、左房操作时间(左房建模及肺静脉定口时间、消融时间)、X线曝光时间以及减少X线曝光量等;且具有更高的12月窦性心律维持率,远期成功率需要进一步随访研究。综上所述,压力监测导管在临床应用中具有较好的前景。
[Abstract]:[background] atrial fibrillation is one of the most common and harmful arrhythmias in clinical work, and the prevalence and number of diseases are increasing with the aging of the population in our country. The main surgical measures for atrial fibrillation include radiofrequency catheter ablation and cryo balloon ablation, compared with cryo balloon ablation and catheterization Radiofrequency ablation is more widely used in clinical practice. It is difficult to improve the effectiveness of catheter ablation, reduce the recurrence rate and ensure the safety of the operation. The pressure monitoring catheter is a new catheter. It has the advantages of monitoring the contact force of the catheter with the heart and its direction in real time. Therefore, compared with other conventional catheter ablation catheter (such as TC catheter), the safety and effectiveness of radiofrequency ablation for atrial fibrillation can be improved theoretically. The research on the application of pressure monitoring catheter (ST catheter) to radiofrequency ablation for atrial fibrillation has become a hot spot. [Objective] pressure monitoring catheter (ST catheter) and ordinary A comprehensive analysis of the safety and clinical efficacy of a cold saline infusion catheter (TC catheter) in the treatment of atrial fibrillation catheter ablation, and a comparison of them, so as to choose the surgical materials more rationally for the patients in the radiofrequency ablation of atrial fibrillation and to develop a more reasonable operation plan to improve the radiofrequency ablation of atrial fibrillation catheter. The short-term and long-term success rate, reducing the probability of postoperative recurrence, improving the safety of atrial fibrillation catheter ablation, and reducing the incidence of postoperative complications. [Methods] randomly selected Paroxysmal atrial fibrillation (PAF) and the diameter of left atrium (left at) in Yuxi People's Hospital from 01 months to May 2016 2014. Rial diameter, LAD) is less than 40mm, and 34 cases of persistent atrial fibrillation (persistent atrial fibrillation, PeAF) undergoing radiofrequency ablation therapy for persistent atrial fibrillation (PeAF) are set up in the study group. Patients with paroxysmal atrial fibrillation treated with common cold saline infusion of NaviStar catheter ablation at the Yuxi People's Hospital at the same time were randomly selected. As well as 34 cases of persistent atrial fibrillation patients with a history of LAD less than 40mm and a course less than 1 years, there were 28 cases in the control group and 22 cases in the study group, with a total of 50 cases, 6 women, 12 cases, 18 cases, and 68 patients in the two group. The average age of the control group was 59.50 + 11.58 years, the average age of the study group was 58.62 + 10.67 years. This study of the patients was studied in this study patient The average age was 28~77 years old, the average age was 58.8 + 11.1 years old. The control group and the study group had 25 cases and 24 PAF, 51 cases in the total. The control group and the study group were 9 cases and 8 cases PeAF respectively. The average ejection fraction of the control group was 62.35 + 4.62%. The average ejection fraction of the study group was 61.29 + 4.68%; the control group cases were in the control group. The average duration of the patients with persistent atrial fibrillation was 7.50 + 1.85 months. The average duration of the patients in the study group was 6.22 + 1.39 months. The average diameter of the left atrium in the control group was 31.87 + 3. 76mm, the average of the study group was 31.52 + 4. 15mm. two groups, the age, the course of atrial fibrillation, the type of atrial fibrillation, the left ventricular ejection fraction, There was no significant difference in baseline data from left atrium (P0. 05). All cases were paroxysmal atrial fibrillation or persistent atrial fibrillation with no significant atrial remodeling and not long history, so the ablation strategy was only bilateral pulmonary vestibule isolation (pulmonary vein isolation, PVI), if pulmonary vein isolation was completed. The patients who were converted to sinus rhythm were given an external synchronous direct current cardioversion (100J-200J) or intravenous injection of Britt (LMG). A few patients with persistent atrial fibrillation still could not maintain sinus rhythm and still have recurrent atrial fibrillation. Patients with atrial flutter were treated with the left atrium line, the mitral isthmus path, and the left atrium. Wall diameter, linear ablation of the three apical isthmus line, and the necessary complex fractionated atrial electrograms (CFAEs). This study was to compare the time of operation, ablation time, X-ray exposure time, X-ray exposure, left atrial model and pulmonary venous opening time, and the statistical difference in the incidence of complications in the two groups. The postoperative follow-up 3,6,12 months compared the two groups of patients with postoperative sinus rhythm maintenance, providing a reliable reference for the selection of surgical instruments and the formulation of surgical procedures in patients with atrial fibrillation. [results all the patients were successfully performed in all the patients in]1.. All the patients were converted to sinus rhythm during the operation, and all patients with.2. could be operated for a long time. No steam explosion, acute pericardial tamponade, cerebral infarction, pulmonary embolism, death, and other serious surgical complications such as.3. were not lost. All the patients were followed up in March, June and December after operation. The study group was compared with the control group: the difference of sinus rhythm maintenance rate in March, June and the difference of sinus rhythm maintenance rate after 4.1 operation The two groups were not statistically significant (94.1% vs.91.2%, P=0.642) (88.23% vs.76. 5%, P=0.203). After operation in December, there were 13 cases in the control group and 4 cases in the study group. The difference of the sinus rhythm maintenance rate in two groups was statistically significant (88. 23%vs.61. 7%, P0.05).4.2 operation time in the study group was significantly shorter than the control group, two groups were worse than the two groups. The difference was statistically significant (154.85 + 28. 62minvs.165.88 + 22.17min, P0.05).4. 3 ring pulmonary venous ablation time in the study group was significantly shorter than the control group. The two groups were statistically significant (89.71 + 20.41 minvs.101.62 + 16.82min, P0.05).4.4 left atrial modeling and pulmonary venous opening time in the study group were significantly shorter than those in the control group. The two groups were significantly different. Statistical significance (8.29 + 2.22 min vs.10. 65 + 2.58 min, P0.05).4.5 X ray exposure time study group was significantly less than the control group, and the difference was statistically significant (28.35 + 5. 34min vs.39. 38 + 6.15min).4.6 x exposure study group was significantly lower than the control group, two group compared with the difference was statistically significant (417.44 + 80. 45mGy vs.585.68 + 9. 5.39mGy, P0. 05) 3 cases of complications in the.4. 7 study group and 2 complications in the control group (8.8% vs.5. 9%, P=0. 16). [Conclusion] the results of this study showed that compared with TC catheter, the use of ST catheter to perform atrial fibrillation catheter ablation can shorten the overall operation time, left atrial operation time (left atrial modeling and pulmonary venous opening time, ablation time), X ray exposure Time and the reduction of X-ray exposure, and with a higher rate of sinus rhythm maintenance in December, the long-term success rate needs further follow-up study. To sum up, the pressure monitoring catheter has a good prospect in clinical application.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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