阵发性房颤射频消融术后左心房电重构及解剖重构的临床研究

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1、贵阳医学院2012届研究生论文中国图书资料分类号：R541.7单位代码：10660学号10660S090172贵阳医学院2012届临床医学硕士专业学位材料(临床论文部分)阵发性房颤射频消融术后左心房电重构及解剖重构的临床研究研究生：田水导师：郑亚西教授吴立荣教授年级：2009级专业：内科学2012年5月15日0贵阳医学院2012届研究生论文目录摘要„„„„„„„„„„„„„„„„„„„„„„1缩略词表„„„„„„„„„„„„„„„„„„„„„3前言„„„„„„„„„„„„„„„„„„„„„„4材料与方法„„„„„„„„„„„„„„„„„„„„5结果„„„„„„„„„„„„„„„„„„„„„„1

2、2讨论„„„„„„„„„„„„„„„„„„„„„„15参考文献„„„„„„„„„„„„„„„„„„„„„25致谢„„„„„„„„„„„„„„„„„„„„„„30英文摘要„„„„„„„„„„„„„„„„„„„„„31论文原创性声明„„„„„„„„„„„„„„„„„„33综述„„„„„„„„„„„„„„„„„„„„„„34附：临床能力考核有关材料：临床轮转考核表(按时间顺序)学术活动情况表(按时间顺序)临床能力考试及学位答辩情况表1贵阳医学院2012届研究生论文阵发性房颤射频消融术后左心房电重构及解剖重构的临床研究专业内科学（心血管病）研究生田水导师郑亚西教授吴立荣教授摘要目的观察阵发性房颤(pa

3、roxysmalatrialfibrillation,PAF)患者肺静脉电隔离(pulmonaryveinisolation,PVI)术前后P波离散度、心率变异性、超声心动图等指标的改变，旨在评价肺静脉电隔离术对阵发性房颤患者左心房电、解剖重构的作用。方法选择2009年1月至2011年11月在贵州省人民医院心内科接受肺静脉电隔离术的阵发性房颤患者50例为研究对象，男性24例，女性26例，年龄22-75（56.1±11.8）岁。于PVI术前、术后1周、术后3月分别采集12导联体表心电图、24小时动态心电图及超声心动图图像，检测P波离散度（Pwavedispersion,Pd），心率变异性（hea

4、rtratevariability,HRV），左心房内径（LAD）、左房容积（LAV）等指标。结果术后1周、术后3月P波最大值（maximumP-waveduration,Pmax）与术前比较均减小（P<0.05）；术后1周、术后3月Pd与术前比较显著减小（P<0.01）；心率变异性指标：全部窦性心率NN间期的标准差(standarddeviationofallnormalsinusR-Rintervals,SDNN)、每5分钟相邻NN间期平均值标准差（standarddeviationoftheaveragenormalsinusR-Rintervalsforall5-minsegments

5、,SDANN）、相邻NN间期差值均方根(root-mean-squareofthesuccessivedifferencesofnormalRRintervals,rMSSD)术后1周与较术前比较明显下降，差异有统计学意义（P<0.05）；SDNN、SDANN、rMSSD术后3月与术前比较差异无统计学意义（P>0.05）；术后1周左房前后径（leftatrialanteriorposteriordiameter,LAAPD）、左房左右径(leftatrialleftrightdiameter,LALRD)、左房上下径(leftatrialsuperiorinferiordiameter,LAS

6、ID)较术前无明显改变（P>0.05）；术后3月LAAPD、LALRD、LASID2贵阳医学院2012届研究生论文较术前减小，差异有统计学意义（P<0.05）；术后1周左房最大容积（leftatrialmaximumvolume,LAVmax）、左房最小容积(leftatrialminimumvolume,LAVmin)、左房收缩前容积（leftatrialprosystolicvolume,LAVp）与术前比较无明显变化，差异无统计学意义（P>0.05）；术后3月LAVmax、LAVmin、LAVp较术前减小，差异有统计学意义（P<0.05）；术后1周、术后3月左房主动排空容积(leftat

7、rialactiveemptyingvolume,LAEV)较术前无明显变化，差异无统计学意义（P>0.05）。结论肺静脉隔离术(PVI)可能是通过对肺静脉电位的隔离，消除了阵发性房颤的触发因素使心房非均质性电活动得到改善，同时可能通过其短期的去迷走神经效应使房颤赖以发生和维持的电生理基质丧失从而逆转心房的电重构；阵发性房颤患者在肺静脉隔离术后3月内左房内径及左房容积均减小，左心房发生了明显的解剖