心房颤动患者射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

CT Imaging Change of Pulmonary Vein Morplology Clinical Study in Atrial Fibrillation Patients Before and after Radiofrequency Ablation

作者: 专业:心血管内科 导师:刘浩 年度:2011 学位:硕士  院校: 广西医科大学

Keywords

CT, Atrial Fibrillation, Pulmonary Veins, CPVA

        目的:利用CT三维成像技术研究心房颤动(房颤)患者行环肺静脉电隔离(CPVA)术前术后肺静脉的形态学变化。方法:房颤患者共28例,行环肺静脉电隔离术(6.5±3.9)个月后进行随访,根据术后有无复发分为成功组(22例)和复发组(6例)。研究随访射频消融术后肺静脉的形态结果学特点和术前做对比分析。应用64排螺旋CT测量环肺静脉电隔离术前、后肺静脉口的径线,截面积,左房容积。结果:CPVA术前术后除左下肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、及4个肺静脉口截面积有明显统计学差别(P<0.05)外,余肺静脉口最大径、最小径、指数及截面积无明显统计学差别(P>0.5)。CPVA成功组术后左心房容积、左上肺静脉口最大径、右上肺静脉口最大径、右上肺静脉口最小径、右下肺静脉口最大径、右下肺静脉口最小径、4个肺静脉口截面积较术前缩小(P<0.5);而左上肺静脉口最小径、左下肺静脉口最大径、左下肺静脉口最小径无明显统计学差别(P>0.05)。复发组术后仅见右下肺静脉口最大径,左下肺静脉口及右下肺静脉口面积较术前减少(P<0.05),余肺静脉指标及左心房容积未见显著差异(P>0.5)。CPVA术后肺静脉的最大径及最小径狭窄率小于50%分别为61.6%及56.3%;狭窄50%~70%分别为3.6%和5.4%。结论:1. CPVA成功后可逆转房颤患者的肺静脉和左心房重构,而复发组未出现明显逆重构。2. CPVA术后可引起部分患者无症状性肺静脉狭窄。
    OBJECTIVE:Using CT three-dimensional image technique to observe the morphological changes of circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF) on the structure of pulmonary vein before and after radiofrequency ablation.METHODS:28 patients with AF who underwent CPVA were followed-up after (6.5±3.9) months. They were divided into the successful group (22 patients) and the recurrence group (6 patients) according to the recurrence of AF. The results of Pulmonary vein morphology study was compared with analysis of preablation, after following up radiofrequency catheter ablation(6.5±3.9) months. Pulmonary vein diameters, cross-sectional area and left atrial volume were measured before and after CPVA using 64-slice multidector computed tomography (CT).RESULTS:Left lower pulmonary vein maximum diameter, right upper pulmonary vein maximum diameter, right upper pulmonary minimum diameter, right lower pulmonary vein maximum diameter, right lower pulmonary minimum diameter and the four pulmonary vein cross-section areas were significant statistical difference(P<0.05) before and after CPVA, but other maximum diameter, minimum diameter, index and cross-sectional area of pulmonary veins was no significant difference(P>0.05).In the successful group, compared with preablation, Left upper pulmonary vein maximum diameter, right upper pulmonary vein maximum diameter, right upper pulmonary minimum diameter, right lower pulmonary vein maximum diameter, right lower pulmonary minimum diameter, the four pulmonary vein cross-section areas and left atrial volume were significant statistical difference(P<0.05) after CPVA, but left upper pulmonary minimum diameter, left lower pulmonary vein maximum diameter, left lower pulmonary minimum diameter were no significant difference (P>0.05). In the recurrence group, compared with preablation, right lower pulmonary vein maximum diameter, Left lower pulmonary vein cross-section areas and right lower pulmonary vein cross-section areas were significant statistical difference(P<0.05) after CPVA, but other pulmonary minimum indexes and left atrial volume were no significant difference (P>0.05). Stenosis of pulmonary vein maximum diameter and pulmonary minimum diameter less than 50% respectively were 61.6% and 56.3% after CPVA; Stenosis reached 50% and 70% respectively were 3.6% and 5.4%.CONCLUSIONS:1.The Pulmonary vein and left atrial in patients with AF can be reversed its reconstruction after CPVA, but the recurrence group did not significantly reverse remodeling. 2. Some patients have asymptomatic pulmonary vein stenosis after CPVA.
        

心房颤动患者射频消融治疗前后肺静脉形态结构CT成像改变的临床研究

中英文缩写对照表4-5
摘要5-7
ABSTRACT7-9
前言10-13
对象与方法13-18
结果18-23
讨论23-28
小结28-29
附图29-31
参考文献31-37
综述37-55
    参考文献48-55
致谢55-56
读研期间发表的文章56
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