【摘要】：目的心房顫動(atrial fibrillation,簡稱房顫)是快速性房性心律失常之中最常見的類型。房顫患者的發(fā)病率隨著中國乃至全球老齡化人群的增長呈現(xiàn)上升走勢,當前國內(nèi)外研究資料顯示,房顫儼然已成為了一個重大的公共衛(wèi)生問題,尤其是持續(xù)性房顫(persistent atrial fibrillation,PeAF)嚴重影響到人們的生活質量。盡管射頻消融術(radiofrequency catheter ablation,RFCA)能有效治療陣發(fā)性房顫,但是,目前RFCA治療PeAF的療效卻不盡如人意,其術后復發(fā)率高。本論文對在我院完成RFCA治療的PeAF患者的術前體表心電圖(electrocardiogram,ECG))f波振幅進行分析,評價其對RFCA治療PeAF的療效。方法連續(xù)選取2014年9月至2016年9月間就診于山東大學附屬千佛山醫(yī)院,首次接受RFCA治療的非瓣膜病持續(xù)性房顫患者31例。收集PeAF患者RFCA術前的一般臨床資料(例如:性別、年齡、房顫持續(xù)時間以及左房內(nèi)徑等),測量PeAF患者術前體表心電圖Ⅱ、AVF以及V1導聯(lián)的f波振幅,并對完成RFCA的房顫患者進行隨訪,根據(jù)術后是否復發(fā)將患者分為兩組:復發(fā)組(11例)以及未復發(fā)組(20例),分析PeAF患者RFCA術前相關臨床指標對RFCA術后復發(fā)的影響,計算預測PeAF患者RFCA術后復發(fā)的臨床指標的ROC曲線下面積,預測指標的界值,特異度及靈敏度。結果與PeAF患者RFCA術后復發(fā)組相比,未復發(fā)組術前體表心電圖AVF導聯(lián)f波平均振幅[(0.087±0.012)mVvs.(0.117±0.024)mV,P=0.001]以及 V1導聯(lián)f波平均振幅[(0.091±0.018)mVvs.(0.130±0.025)mV,P0.001]較前者高,并且,未復發(fā)組房顫平均持續(xù)時間[(28.36± 16.05)月vs.(16.35±12.61)月,P0.05]較前者短,差異均有統(tǒng)計學意義。Pearson相關性分析顯示:房顫平均持續(xù)時間與PeAF患者RFCA術前體表心電圖AVF導聯(lián)f波平均振幅呈線性負相關(r=-0.371,P=0.040),而且,與V1導聯(lián)f波平均振幅呈線性負相關(r=-0.394,P=0.028),PeAF患者RFCA術前體表心電圖AVF導聯(lián)f波平均振幅以及V,導聯(lián)平均振幅呈線性正相關(r=0.444,P=0.012)。多因素Logistic回歸分析顯示:房顫平均持續(xù)時間[P=0.048,OR=1.086,OR 95%C.I.(1.001,1.178)]以及 PeAF 患者RFCA術前體表心電圖V,導聯(lián)f波平均振幅[P = 0.040,OR = 0.270,OR 95%C.I.(0.078,0.940)]是預測RFCA術后復發(fā)的危險因素。ROC曲線顯示:房顫平均持續(xù)時間預測PeAF患者RFCA術后復發(fā)的ROC曲線下面積為0.736(P=0.032),其預測RFCA術后復發(fā)的界值、特異度及敏感度分別為13.5個月,60%,81.8%。V,導聯(lián)f波平均振幅預測PeAF患者RFCA術后復發(fā)的ROC曲線下面積為0.898(P0.001),其預測術后復發(fā)的界值、特異度及敏感度分別為0.095mV,95%,72.7%。結論RFCA術前房顫持續(xù)時間以及術前體表心電圖V,導聯(lián)f波振幅可作為預測PeAF患者術后復發(fā)的預測指標,具有一定的臨床參考價值。PeAF患者RFCA術前V1導聯(lián)f波振幅低、房顫持續(xù)時間長的患者,RFCA術后更易復發(fā)。
[Abstract]:Objective Atrial fibrillation (atrial fibrillation,) is the most common type of atrial tachyarrhythmia. The incidence of atrial fibrillation (AF) patients is increasing with the increase of aging population in China and even the whole world. Current research data at home and abroad show that AF has become a major public health problem, especially persistent atrial fibrillation (persistent atrial fibrillation,). PeAF seriously affects people's quality of life. Although radiofrequency ablation (radiofrequency catheter ablation,RFCA) can effectively treat paroxysmal atrial fibrillation, the efficacy of RFCA in the treatment of PeAF is not satisfactory, and its recurrence rate is high. In this paper, we analyzed the amplitude of electrocardiogram,ECG) f wave in PeAF patients who completed RFCA treatment in our hospital, and evaluated the effect of RFCA on PeAF. Methods from September 2014 to September 2016, 31 patients with persistent atrial fibrillation who were treated with RFCA for the first time at Qianfushan Hospital affiliated to Shandong University were selected. To collect general clinical data (such as gender, age, duration of atrial fibrillation and left atrial diameter, etc.) before RFCA in patients with PeAF, and to measure the amplitude of F-wave of electrocardiogram 鈪，

本文編號：2314170