本文選題：心臟再同步化治療 + 慢性心力衰竭�。� 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:觀察心臟再同步化治療(CRT)前后心力衰竭患者血清氨基末端B型腦鈉肽前體(NT-proBNP)及紅細(xì)胞分布寬度(RDW)濃度,探討RDW和NT-proBNP反應(yīng)對(duì)CRT預(yù)后的價(jià)值。方法:選取2015年04月~2016年04月因慢性心力衰竭(CHF)在我院住院的患者20例,男9例,女11例,年齡53~78(68.3±7.81)歲。檢測(cè)CRT術(shù)前、術(shù)后6個(gè)月的血液學(xué)參數(shù)與超聲心動(dòng)圖參數(shù).定義隨訪終點(diǎn)為全因死亡(包括心臟移植)或心衰再住院。定義對(duì)CRT有反應(yīng)為術(shù)后6個(gè)月超聲心動(dòng)圖檢測(cè)左室收縮末期容積(LVESV)≥15%。所得數(shù)據(jù)采用SPSSl6.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析:計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示,組間比較采用獨(dú)立樣本t檢驗(yàn)或,組內(nèi)比較采用配對(duì)樣本t檢驗(yàn);計(jì)數(shù)資料采用Fisher確切概率法,兩變量之間采用線性相關(guān)分析(r)。以p=0.05為檢驗(yàn)水準(zhǔn),p0.05即為差異有顯著性。結(jié)果:所有患者手術(shù)順利,術(shù)中無(wú)急性左心衰竭、心律失常等情況發(fā)生,術(shù)后定期門(mén)診程控起搏器狀態(tài),均工作正常。根據(jù)心超指標(biāo)將患者分為CRT有反應(yīng)組和CRT無(wú)反應(yīng)組,有反應(yīng)組14例(70%),無(wú)反應(yīng)組6例(30%),兩組在年齡、性別、心力衰竭的病因、吸煙史、高血壓、糖尿病、高血脂史、NYHA心功能分級(jí)、臨床用藥(ARB/ACEI類(lèi)、利尿劑、β-受體阻滯劑、洋地黃類(lèi))等方面無(wú)明顯差異(p0.05)。心臟再同步化治療前,左室功能參數(shù)(LVEF、LVESV、LVEDD)、血清NT-pro BNP、RDW水平,在有反應(yīng)組和無(wú)反應(yīng)組之間無(wú)明顯的差異(p0.05)。CRT治療后6個(gè)月,兩組參數(shù)均有明顯差異(p0.05)。在CRT有反應(yīng)組,左室功能參數(shù)(LVEF、LVESV、LVEDV)、血清NT-pro BNP水平,治療前、后差異均有統(tǒng)計(jì)學(xué)意義(P0.05),RDW水平較術(shù)前無(wú)明顯變化(p0.05)。在CRT無(wú)反應(yīng)組,左室功能參數(shù)(LVEF、LVESV、LVEDV)、血清NT-pro BNP水平,治療前、后差異均無(wú)差異(P0.05),RDW水平較術(shù)前明顯增高,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。血清NT-pro BNP水平與LVESV、LVEDD呈正相關(guān)(r值分別為0.719、0.923;p0.01),與LVEF呈負(fù)相關(guān)(r=-0.897;p0.01)。血清RDW水平與LVESV、LVEDD呈正相關(guān)(r值分別為0.759、0.617;p0.01),與LVEF呈負(fù)相關(guān)(r=-0.740;p0.01)。血清RDW水平與NT-proBNP呈正相關(guān)(r=0.513;p0.01)。結(jié)論:通過(guò)檢測(cè)患者術(shù)前及術(shù)后血清中RDW、NT-pro BNP水平變化可以對(duì)心臟再同步化治療臨床療效做出評(píng)價(jià)。
[Abstract]:Objective: To observe the concentration of serum amino terminal B type natriuretic peptide precursor (NT-proBNP) and red cell distribution width (RDW) in patients with heart failure before and after cardiac resynchronization therapy (CRT), and to explore the value of RDW and NT-proBNP reaction to the prognosis of CRT. Methods: 20 cases of chronic heart failure (CHF) hospitalized in our hospital from 04 month ~2016 year, 2015, and 9 men 9 were selected. Cases, 11 women, age 53~78 (68.3 + 7.81) years of age. The hematological parameters and echocardiographic parameters were measured before CRT operation and 6 months after operation. The end point of follow-up was defined as all causes of death (including heart transplantation) or heart failure and rehospitalization. The CRT was defined by 6 months after 6 months of echocardiography to determine the left ventricular end systolic volume (LVESV) more than 15%. by S Statistical analysis of PSSl6.0 statistical software: measurement data were expressed with mean standard deviation of mean number, independent sample t test or paired sample t test were used in groups, and Fisher exact probability method was used for counting data and linear correlation analysis (R) between the two variables. P=0.05 was used as the test level and P0.05 was significant difference. Result: all patients were operated smoothly, without acute left heart failure and arrhythmia, and regular pacemaker state was normal after operation. According to the heart super index, the patients were divided into CRT reaction group and CRT non reaction group, 14 cases (70%), 6 cases (30%), and two groups in age, sex, heart failure. Smoking history, hypertension, diabetes, hyperlipidemia, NYHA cardiac function classification, clinical medication (ARB/ACEI, diuretic, beta blocker, digitalis), and so on, there were no significant differences (P0.05). Before cardiac resynchronization therapy, left ventricular function parameters (LVEF, LVESV, LVEDD), serum NT-pro BNP, RDW level, no obvious between the reaction group and the non reaction group. 6 months after.CRT treatment, the parameters of the two groups were significantly different (P0.05). In the CRT reaction group, the left ventricular function parameters (LVEF, LVESV, LVEDV), the serum NT-pro BNP level, before the treatment, the difference was statistically significant (P0.05), RDW level than before the operation (P0.05). There was no difference in serum NT-pro BNP level before treatment (P0.05), and the level of RDW was significantly higher than that before operation (P0.05). The serum NT-pro BNP level was positively correlated with LVESV and LVEDD (r value was 0.719,0.923; P0.01). 759,0.617; P0.01) has a negative correlation with LVEF (r=-0.740; P0.01). Serum RDW level is positively correlated with NT-proBNP (r=0.513; P0.01). Conclusion: the changes in NT-pro BNP level can be used to evaluate the clinical efficacy of cardiac resynchronization by detecting RDW in the sera before and after the operation.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.6

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本文編號(hào)：1847751