导管射频消融治疗对阵发性房颤患者左房内径及近期预后的影响

发布时间：2019-05-12 06:39

【摘要】：目的:阵发性房颤(PAF)反复发作,导致左心房扩大,心脏泵血功能减低,心房内附壁血栓形成,甚至心力衰竭、栓塞等严重并发症,危及患者生命健康。本研究通过比较导管射频消融术(RFCA)与药物保守治疗对阵发性房颤患者左房内径及近期预后的影响,评价导管射频消融对PAF患者治疗的安全性与有效性。方法:入选56例阵发性房颤患者,根据患者及家属意愿,分成两组,射频消融组32例,药物治疗组24例。院外随访1年,记录房颤复发、患者再入院率、血栓栓塞事件等相关并发症的发生,并行超声心动图检测患者左心房内径(LAD)、右心房内径(RAD)、左心室内径(LVD)、右心室内径(RVD)、左室后壁厚度(LVPW)、左心室射血分数(LVEF)指标与治疗前相对比,比较两种治疗方法对患者左心房内径及近期预后的影响。所有数据均采用SPSS 21软件包进行统计分析。计量资料用均数±标准差表示,计数资料用率或百分比表示。采用独立样本t检验或配对t检验对数据进行分析。P0.05为差异有统计学意义。结果:1两组患者的基线情况两组在年龄、性别、身高、体重、房颤病史、合并高血压比例、合并糖尿病比例、LAD、RAD、LVD、RVD、LVPW、LVEF方面差异均无统计学意义(P0.05)2两组患者治疗1年后与治疗前超声心动图各指标的比较2.1射频消融组治疗前后超声心动图各项指标的比较术后1年 LAD 较术前显著缩小(35.13±3.66mmvs 37.03±4.43mm,P=0.000),提示阵发性房颤患者行射频消融治疗1年后左心房内径减小。术后1年与术前相比,RAD、LVD、RVD、LVPW、LVEF差异无统计学意义(P0.05)。2.2药物治疗组治疗前后超声心动图各项指标的比较治疗1年后LAD较治疗前显著扩大(39.79±3.97mm vs 37.92 ±3.92mm,P=0.000);LVD较治疗前显著扩大(49.38±5.20mm vs 47.33±5.26mm,P=0.023)。提示阵发性房颤患者药物治疗1年后左心房、左心室内径增大。治疗1年后,RAD、RVD、LVPW、LVEF较治疗前无统计学意义(P0.05)。3两组患者治疗1年后超声心动图各项指标的比较治疗1年后射频消融组与药物治疗组相比,LAD显著缩小(35.13±3.66mm vs 39.79±3.97mm,P=0.000);LVEF显著提高(65.58±5.71%vs 61.78±6.88%,P=0.028)。提示对于阵发性房颤患者,导管射频消融较药物保守治疗可缩小左心房内径,提高左室射血分数。射频消融组与药物治疗组相对比,RAD、LVD、RVD、LVPW差异无统计学意义(P0.05)。4两组患者近期预后事件发生观察4.1射频消融组32例患者均顺利完成手术,有1例患者术后出现少量心包积液。经1年的随访,维持窦性心律者30例(93.75%)。2例患者房颤复发,其中1例为无症状性房颤复发;另1例患者因症状不耐受再次入院。均无心力衰竭、血栓栓塞事件发生。4.2药物治疗组经1年的随访,24例患者中维持窦性心律者15例(62.5%)。9例患者中,4例因房颤复发症状不耐受再次入院,其中1例出现急性左心衰,1例出现新发脑梗塞;2例进展为持续性房颤;3例仍为阵发性房颤。结论:与单纯药物治疗相比,导管射频消融可降低阵发性房颤的复发率,缩小左心房内径,改善患者近期预后,提高患者生活质量。
[Abstract]:Objective: The repeated episodes of paroxysmal atrial fibrillation (PAF), which lead to the enlargement of the left atrium, the reduction of the blood function of the heart pump, the formation of mural thrombus in the atria, and even the serious complications such as heart failure and embolism, endanger the life and health of the patients. The purpose of this study was to evaluate the effect of catheter radiofrequency ablation (RFCA) and conservative treatment on the inner diameter of left atrial and the near-term prognosis of patients with paroxysmal atrial fibrillation, and to evaluate the safety and effectiveness of catheter RF ablation on the treatment of PAF. Methods:56 patients with paroxysmal atrial fibrillation were divided into two groups according to the wishes of the patient and the family. The patients were followed up for 1 year to record the occurrence of related complications such as the recurrence of AF, the readmission rate of the patient and the event of thromboembolic events. The left atrial diameter (LAD), the right atrial diameter (RAD), the left ventricular inner diameter (LVD), and the right ventricular internal diameter (RVD) of the patient were detected by the parallel echocardiography. The left ventricular posterior wall thickness (LVPW), the left ventricular ejection fraction (LVEF) index and the pre-treatment relative ratio were compared, and the effect of the two treatment methods on the left atrial diameter and the near-term prognosis of the patient was compared. All data were analyzed by SPSS 21 software package. The measurement data is represented by a mean square standard deviation, a count data rate, or a percentage. The data is analyzed using an independent sample t-test or a paired t-test. The difference of P0.05 was of statistical significance. Results: There were two groups of patients with baseline in age, gender, height, body weight, history of atrial fibrillation, combined hypertension, combined type of diabetes, LAD, RAD, LVD, RVD, and LVPW. There was no significant difference in LVEF (P0.05). There was no significant difference in LVEF between the two groups (P <0.05). The comparison of the two groups after 1 year and before and after treatment was significantly reduced in 1 year after the operation (35.13, 3.66 mm vs. 37.03, 4.43 mm, P = 0.000). It was suggested that the left atrial diameter of patients with paroxysmal atrial fibrillation after 1 year was reduced. There was no significant difference in RAD, LVD, RVD, LVPW and LVEF between 1 year and 1 year after operation (P0.05). LVD was significantly enlarged prior to treatment (49.38-5.20 mm vs 47.33-5.26 mm, P = 0.023). It was suggested that the internal diameter of left atrium and left ventricle of patients with paroxysmal atrial fibrillation after 1 year were increased. After 1 year of treatment, there was no significant difference in RAD, RVD, LVPW and LVEF (P0.05). The LVEF was significantly increased (65.58% 5.71% vs 61.78% 6.88%, P = 0.028). It is suggested that for patients with paroxysmal atrial fibrillation, the radiofrequency ablation of the catheter can reduce the inner diameter of the left atrium and increase the left ventricular ejection fraction. There was no significant difference in the relative ratio, RAD, LVD, RVD and LVPW in the radio-frequency ablation group (P0.05). After 1 year of follow-up,30 cases (93.75%) of the patients with atrial fibrillation were maintained. The recurrence of AF in 2 patients, one of which was asymptomatic AF, and the other was admitted to the hospital again due to the symptoms. There were no cases of heart failure and thromboembolic events. The 1-year follow-up of the drug-treated group and 15 (62.5%) of the 24 patients with cardiac rhythm in 24 patients (62.5%). Among the 9 patients,4 of the 9 patients were admitted to the hospital again due to the recurrent symptoms of AF, one of which had acute left heart failure and one with new cerebral infarction; 2 cases progressed to persistent AF;3 were still paroxysmal atrial fibrillation. Conclusion: Compared with pure drug therapy, radiofrequency ablation of catheter can reduce the recurrence rate of paroxysmal atrial fibrillation, narrow the inner diameter of the left atrium, improve the recent prognosis of patients and improve the quality of life of patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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