心房颤动电转复后左心耳顿抑的预测因子  

Predictors of occurrence of left atrial appendage stunning after electrical cardioversion of atrial fibrillation to sinus rhythm

作　　者：杨沙宁[1] 黄从新[1] 胡晓军[1] 金立军[1] 李风翥[2] 彭水先[2] 

机构地区：[1]武汉大学人民医院心内科,430060 [2]湖北省荆州市第一人民医院

出　　处：《中华心律失常学杂志》2004年第6期366-370,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　研究非瓣膜病心房颤动 (房颤 )患者中 ,心脏电转复后左心耳顿抑的危险因素与预测因子。方法　 6 8例房颤电转复成功患者 ,分为左心耳顿抑组与对照组 ,通过单因素及多元逐步逻辑回归分析 ,将临床和超声影像学指标作为待选变量 ,对电转复后左心耳顿抑的危险因素进行研究。结果单因素分析发现 ,左心耳顿抑组与对照组间差异有统计学意义的指标有 :房颤持续时间 [(10 6± 15 6 )周vs(2 2 0± 2 0 1)周 ,P <0 0 5 ]、左心房内径 [(43 8± 7 7)mmvs(48 5± 6 2 )mm ,P <0 0 1) ]、左心房排空分数 [(0 32± 0 0 8)vs(0 2 7± 0 0 9) ,P <0 0 5 ]、左心室射血分数 [(0 5 0± 0 0 6 )vs(0 4 6± 0 0 6 ) ,P<0 0 1]、最大复律能量 [(96 8± 6 5 8)Jvs(15 6 8± 10 0 8)J,P <0 0 1]、累积转复能量 [(14 6 8± 14 2 6 )Jvs(2 90 5± 2 4 2 1)J,P <0 0 1]和电转复次数 [(1 7± 0 9)次vs(2 4± 1 2 )次 ,P <0 0 5 ]。多元逐步逻辑回归分析发现 ,房颤持续时间 (β =0 10 5 ,P <0 0 1)、左心房内径 (β =0 196 ,P <0 0 1)、左心室射血分数 (β =- 2 0 5 4 9,P <0 0 1)、转复累积能量 (β =0 0 0 4 ,P <0 0 5 )是左心耳顿抑的独立危险因素。 结论　房颤持续时间、左心房内径?ObjectiveTo determine the predictors and risk factors of occurrence of atrial appendage stunning after electrical cardioversion of non-valvular atrial fibrillation.MethodsClinical and echocardiographic variables were analyzed by univariate regression and multivariate logistic regression in order to investigate the relationship between the occurrence of left atrial appendage stunning and these factors in 68 patients with non-valvular atrial fibrillation.ResultsUnivariate analysis revealed that persisting time of atrial fibrillation[(10.6±15.6)weeks vs(22.0±20.1)weeks,P<0.05],left atrial diameter [(43.8±7.7)mm vs (48.5±6.2) mm,P<0.01],left atrial emptying fraction[(0.32±0.08)vs (0.27±0.09),P<0.05],left ventricular ejection fraction[(0.50±0.06)vs(0.46±0.06),P<0.01],maximum energy[(96.8±65.8)J vs(156.8±100.8)J,P<0.01],cumulative energy [(146.8±142.6) J vs(290.5±242.1) J,P<0.01]and times of electrical cardioversion[(1.7±0.9)vs (2.4±1.2),P<0.05]were risk factors of occurrence of left atrial appendage stunning.However,backward stepwise multivariate logistic regression analysis identified only persisting time of atrial fibrillation(β=0.105,P<0.01),left atrial diameter(β=0.196,P<0.01),left ventricular ejection fraction(β=-20.549,P<0.01)and cumulative energy of electrical cardioversion(β=0.004,P<0.05)were significant and independent predictors of left atrial appendage stunning.ConclusionPersisting time of atrial fibrillation,left atrial diameter,left ventricular ejection fraction and cumulative energy of electrical cardioversion were independent predictors of left atrial appendage stunning.

关 键 词：左心耳 电转复 心房颤动 预测因子 左心室射血分数 左心房内径 对照组 患者 复律 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病]