心房颤动射频消融术后左房顿抑的变化及阿托伐他汀钙对其作用

发布时间：2018-07-12 08:26

本文选题：心房顿抑 + 左心房功能　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:心房颤动是临床上较为常见的心律失常之一,众多研究显示,房颤转为窦性心律后一段时间内存在栓塞风险,其原因和即使转复窦律后依旧存在心房顿抑及心房功能恢复不全有关。心房顿抑是指房颤和房扑转为窦性心律后出现心房、心耳机械功能暂时性的失调[11]。随着导管介入技术的发展,射频消融术已成为近年来针对房颤进行的先进的介入治疗手术。然而因房颤射频消融术后一段时间内仍存在心房顿抑及左心房功能不全[1],因此在一定程度上影响了房颤射频消融的治疗效果。而心房顿抑的确切机制、持续时间、如何减少房颤射频消融术后心房顿抑及尽快改善左心房功能成为目前国内外研究的热点,且没有明确的结论。有研究认为炎症和氧化应激在房颤的发生中起到重要作用[2-4],并且心房顿抑可能与心房肌细胞的炎症、氧化应激、纤维化等有关[5]。另外,近年来人们发现他汀类药物除具有降脂作用外,还有抗炎、抗氧化、改善心肌重构、抗心肌纤维化等作用。但他汀是否能改善房颤射频消融术后的左房顿抑和功能目前尚不知晓。因此本试验选用阿托伐他汀钙,用于房颤射频消融的病人,比较他汀组及非他汀两组患者房颤射频消融术后的左房功能的变化及心房顿抑的发生,观察其是否能改善左心房的功能,减轻心房顿抑的发生。并试图研究房颤射频消融术后心房顿抑的机制及具体时间。这可为房颤的临床治疗提供依据。方法:研究对象为2013年12月-2015年1月在河北医科大学第二医院心内一科住院的房颤且拟行射频消融手术的患者,包括持续性房颤及阵发性房颤患者,共49例。随机分为他汀组和非他汀组。他汀组:手术前3~4天在常规房颤治疗基础上加用阿托伐他汀钙(辉瑞医药)20mg口服1/晚;非他汀组:采用房颤常规治疗。所有入选患者在治疗前经病史询问、体格检查、实验室检查、常规心电图及动态心电图检查、经食道心脏彩超检查等术前检查。射频消融手术均由同一术者进行,并均行统一术式即环肺静脉隔离术。如术中因特殊情况改变术式则从本研究中剔除。所有患者分别于术前、术后1周、术后2周、术后3周、术后4周采用心脏超声二维斑点追踪技术观察心房顿抑和左房功能指标。数据采用SPSS13.0进行统计分析,计量资料服从正态分布时用均数±标准差(x—±s)表示,非正态分布时采用中位数(四分位数间距)表示,即M(QR)。组间及组内比较采用重复测量混合线性模型进行比较,相关因素分析采用多元线性回归分析,均数比较采用t检验。P0.05认为有统计学意义。结果:所有病例均成功完成房颤射频消融术,术式均为环肺静脉隔离术,无肺静脉狭窄、血栓栓塞事件、心包填塞、左房食管瘘等并发症。1两组患者的一般情况非他汀组患者男性18例,女性10例,阵发性房颤19例,持续性房颤9例;他汀组患者男性14例,女性7例,阵发性房颤14例,持续性房颤7例;两组患者年龄、性别、阵发性及持续性比例差异无统计学意义(P0.05)。2心脏超声指标:2.1左心房结构指标:左心房直径(LAD):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。2.2心脏功能指标2.2.1左心房射血分数(LAEF%):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异有统计学意义(P0.05),他汀组术后1周明显低于术前(P0.05),术后2周逐渐升高,但依然低于术前(P0.05),术后3周与术前比较差异无统计学意义(P0.05),术后4周高于术前(P0.05);非他汀组术后1周、2周、3周LAEF%逐渐升高,但均低于术前(P0.05),术后4周与术前比较差异有统计学意义(P0.05),术后4周高于术前;组间比较,他汀组在术后各时间段LAEF%均高于非他汀组(P0.05)。2.2.2 A峰:组内比较,他汀组及非他汀组术前、术后1周、术后2周、术后3周、术后4周间差异有统计学意义(P0.05),各时间段A峰有逐渐增高的趋势;组间比较,他汀组及非他汀组间差异具有统计学意义(P0.05),他汀组在术后各时间段A峰均高于非他汀组。2.2.3 E峰:组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。2.2.4 E/A值:组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异有统计学意义(P0.05),他汀组及非他汀组术后各时间段较术前有升高趋势;组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。2.2.5 A峰速度时间积分(A-VTI):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间无明显差异(P0.05)。2.2.6 e’:组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。2.3左心房应变指标:2.3.1左心房应变(S):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异具有统计学意义(P0.05),他汀组术后各时间段左心房应变高于非他汀组。2.3.2左心房应变率(SR)2.3.2.1左心室收缩期(SRs):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05),组间他汀组及非他汀组间差异具有统计学意义(P0.05),他汀组术后各时间段左心房应变率在左心室收缩期显著高于非他汀组。2.3.2.2左心室舒张早期(SRe):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。2.3.2.3左心房收缩期(SRa):组内比较,术前、术后1周、术后2周、术后3周、术后4周间差异无统计学意义(P0.05);组间比较,他汀组及非他汀组间差异无统计学意义(P0.05)。3左房功能与年龄、左房直径(LAD)、是否用他汀、血浆低密度脂蛋白(LDL-c)相关性分析结果:LAEF:术后1周与LAD、是否用他汀相关(P0.05);术后2周、3周、4周仅与LAD相关(P0.05)。A峰:术后1周与LAD、年龄相关(P0.05);术后2周与是否用他汀相关(P0.05);术后3周与LAD、年龄、是否用他汀、血浆低密度脂蛋白(LDL-c)都不相关(P0.05);术后4周与年龄、LAD相关(P0.05)。结论:1房颤射频消融术后一段时间内存在左心房顿抑及左心房功能下降,且术后第1周最明显,以后逐渐恢复,因此房颤射频消融术后需要抗凝治疗,术后第1周最重要。2非他汀组房颤射频消融术后左心房顿抑及左心房功能下降持续约4周,因此至少需抗凝4周。3他汀组房颤射频消融术后左心房顿抑及左心房功能下降持续约3周,因此至少需抗凝3周,且术后1周、2周、3周、4周左心房射血分数均得到改善。4阿托伐他汀钙可以改善房颤射频消融术后左心房功能、缩短心房顿抑的时间。
[Abstract]:Objective: atrial fibrillation is one of the most common arrhythmias in the clinic. Numerous studies have shown that atrial fibrillation is involved in the risk of embolization at a time after sinus rhythm. The cause is associated with atrial stunning and atrial functional recovery even after the cardioversion sinus rhythm. Atrial stunning refers to atrial fibrillation and atrial flutter after sinus rhythm. [11]. has become an advanced interventional therapy for atrial fibrillation in recent years with the development of interventional catheter technology. However, there is still atrial stunning and left atrial dysfunction [1] for a period of time after radiofrequency ablation for atrial fibrillation, so it affects atrial fibrillation to a certain extent. The exact mechanism and duration of atrial stunning, duration, how to reduce atrial stunning after radiofrequency ablation and improve the function of the left atrium as soon as possible after radiofrequency ablation of atrial fibrillation has become a hot spot at home and abroad, and there is no clear conclusion. It is considered that inflammation and oxidative stress play an important role in the occurrence of atrial fibrillation, [2-4], and Atrial stunning may be associated with [5]. in atrial myocyte inflammation, oxidative stress, and fibrosis. In recent years, statins have been found to have anti-inflammatory, antioxidant, myocardial remodeling, and anti myocardial fibrosis in addition to lipid lowering in recent years. But whether statins can improve left atrial stunning and function after atrial fibrillation radiofrequency ablation Therefore, atorvastatin calcium was used in this study to compare the changes of left atrial function and the occurrence of atrial stunning after radiofrequency ablation in statins and non statin groups in patients with atrial fibrillation radiofrequency ablation, and to observe whether they could improve the function of the left atrium, reduce the occurrence of atrial stunning, and try to study the radiofrequency of atrial fibrillation. The mechanism and specific time of atrial stunning after ablation can provide a basis for clinical treatment of atrial fibrillation. Methods: a total of 49 patients, including persistent atrial fibrillation and paroxysmal atrial fibrillation, were randomly divided into 49 patients who were hospitalized at the heart of the second hospital of Hebei Medical University, December 2013, in the second hospital of Hebei Medical University, including patients with persistent atrial fibrillation and paroxysmal atrial fibrillation. Statins and non statins. Statins group: atorvastatin calcium (Pfizer) 20mg was added to 1/ night on the basis of conventional atrial fibrillation therapy 3~4 days before the operation; non statin group was treated with atrial fibrillation routine treatment. All selected patients underwent medical history inquiry, physical examination, laboratory examination, routine electrocardiogram and dynamic electrocardiogram examination before treatment, through esophagus. Radiofrequency ultrasound examination, such as preoperative examination. Radiofrequency ablation was performed by the same surgeon, and all the patients were treated by a unified surgical method of circumferential pulmonary vein isolation. For example, the surgical procedure was removed from this study. All patients were removed from the study, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, and two dimensional echocardiography after 4 weeks after operation. The indexes of atrial stunning and left atrial function were observed. The data were statistically analyzed by SPSS13.0, and the data were expressed with mean mean + standard deviation (x - s) when the measurement data were subject to normal distribution. The median (four quantile spacing) was expressed in the non normal distribution, that is, M (QR). Multivariate linear regression analysis was used, and the average number was compared with t test.P0.05. Results: all cases successfully completed atrial fibrillation radiofrequency ablation successfully. All cases were circumferential pulmonary vein isolation, no pulmonary vein stenosis, thromboembolism events, pericardial tamponade, left atrial esophagus fistula and other complications in the two groups of non statins. There were 18 male, 10 female, 19 paroxysmal atrial fibrillation, 9 persistent atrial fibrillation, 14 statins, 7 female, 14 paroxysmal atrial fibrillation and 7 patients with persistent atrial fibrillation (7 cases). The difference of age, sex, paroxysmal and persistent ratio in the two group was not statistically significant (P0.05).2 cardiac ultrasound index: 2.1 left atrium index: left atrium diameter (left atrium diameter). LAD): in group comparison, there was no statistically significant difference between 1 weeks after operation, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05). The difference between statin group and non statin group was not statistically significant (P0.05).2.2 cardiac function 2.2.1 left atrial ejection fraction (LAEF%): group comparison, preoperative, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, and 4 weeks postoperative difference after operation. The difference was statistically significant (P0.05). 1 weeks after operation in statin group was significantly lower than that before operation (P0.05), and gradually increased in 2 weeks after operation, but still lower than before operation (P0.05). There was no statistical difference between 3 weeks after operation (P0.05) and 4 weeks after operation (P0.05), and 1 weeks, 2 weeks and 3 weeks after operation in non statin group, but lower than before operation (P0.05) and 4 weeks after operation. The difference was statistically significant (P0.05), and 4 weeks after operation was higher than that before the operation. The LAEF% in the statins group was higher than that of the non statin group (P0.05).2.2.2 A peak after the operation. The difference between the statin group and the non statin group was statistically significant (P0.05) at 4 weeks after the operation, 3 weeks after the operation, and 4 weeks after the operation (P0.05), and the A peak in each time period. The tendency to increase gradually; the difference between statin group and non statin group was statistically significant (P0.05), and the A peak of statins group was higher than that of non statin group.2.2.3 E peak in all time periods after operation: before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks postoperatively and 4 weeks after operation, the difference was not statistically significant (P0.05); statin group and non statin group were compared. There was no statistically significant difference (P0.05).2.2.4 E/A value: before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, 4 weeks after operation, there was a statistically significant difference (P0.05). The difference between statin group and non statin group was higher than that before operation, and there was no statistically significant difference (P0.05).2.2.5 A peak speed between the statin group and the non statin group. Degree time integral (A-VTI): in group comparison, there was no significant difference between preoperative, 1 weeks, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05); there was no significant difference between statin group and non statin group (P0.05).2.2.6 e: group comparison, before operation, 1 weeks after operation, 2 weeks postoperatively, 3 weeks after operation (P0.05), and there was no significant difference between the groups (P0.05). Comparison, there was no significant difference between statin group and non statin group (P0.05).2.3 left atrial strain index: 2.3.1 left atrial strain (S): before operation, 1 weeks after operation, 2 weeks after operation, 3 weeks after operation, there was no significant difference between 4 weeks after operation (P0.05); the difference between statin group and statin group was statistically significant (P0.05), statins group The left atrial strain was higher than the left atrial strain rate (SR) 2.3.2.1 left ventricular systolic phase (SRs) of the left atrium (.2.3.2) in the non statin group. The difference was not statistically significant (P0.05) before the operation, 1 weeks after the operation, 2 weeks after the operation, 3 weeks after the operation (P0.05), and the difference between the statin group and the statin group was statistically significant (P0.05). The left atrial strain rate in the left ventricle was significantly higher than that in the left ventricular diastolic early diastolic phase (SRe) in the left ventricular systole (.2.3.2.2). The difference was not statistically significant (P0.05) before the operation, 1 weeks after operation, 2 weeks after the operation, 3 weeks after the operation and 4 weeks after the operation. There was no statistically significant difference between the statin group and the non statin group (P0.05).2.3.2.3 left atrium systolic phase. (SRa): in group comparison, there was no statistically significant difference between preoperative, 1 weeks, 2 weeks after operation, 3 weeks after operation and 4 weeks after operation (P0.05). There was no statistically significant difference between statins and non statin groups (P0.05).3 left atrial function and age, left atrial diameter (LAD), statins and plasma low density lipoprotein (LDL-c) correlation analysis: 1 after LAEF: Week and LAD, statins correlation (P0.05); 2 weeks, 3 weeks after operation, 4 weeks only with LAD (P0.05).A peak: 1 weeks after operation, age related (P0.05); 2 weeks after operation with statin related (P0.05); 3 weeks and LAD after operation, age, statins, plasma low density lipoprotein (LDL-c) are not related (P0.05); 4 weeks after 4 weeks with age, LAD related. Junctions. 1 after radiofrequency ablation of atrial fibrillation, the left atrium and left atrium were depressed and the left atrium function decreased, and the most obvious after first weeks after operation, and then gradually resumed. Therefore, anticoagulant therapy was needed after radiofrequency ablation of atrial fibrillation. The most important.2 non statins group after radiofrequency ablation was the left atrial stunning and left atrial function decline for about 4 weeks after the ablation of atrial fibrillation. Therefore, at least 4 weeks of anticoagulant.3 statin group, left atrial stunning and left atrium function decline lasted about 3 weeks after radiofrequency ablation, and at least 3 weeks of anticoagulation, and 1 weeks, 2 weeks, 3 weeks and 4 weeks of left atrial ejection fraction were improved by.4 atorvastatin calcium to improve left atrial function after AF ablation and shorten atrial stunning. Room.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.75

【参考文献】