心房颤动自发复律对老年患者左房功能的影响  

Left atrial function after spontaneous cardioversion of atrial fibrillation to sinus rhythm in the elderly

作　　者：赵玮[1] 祁芸云[1] 欧阳福珍[1] 刘芳[1] 

机构地区：[1]北京大学第一医院老年科,北京市100034

出　　处：《中华老年多器官疾病杂志》2005年第1期26-29,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的本文探讨老年患者心房颤动自发复律后心房功能恢复的特点。方法采用SONOS5500型彩色多普勒血流显像仪,观察20例老年对照组和20例非瓣膜病阵发性心房颤动(PAF)患者在心房颤动自发复律后24h,72h及7d左心房收缩功能。观察以下指标:①左房内径LAD和左室内径LVD;②左室射血分数(LVEF);③二尖瓣E峰峰值速度E(cms);④二尖瓣A峰峰值速度A(cms);⑤取心尖四腔切面AQ技术观察左房:左房最大容积LAVmax,左房最小容积LAVmin,左房收缩期前容积LAVp,左房主动排空容积LAAEV=LAVpLAVmin,左房主动排空分数LAAEF(%)=LAAEVLAVp。结果老年PAF组较老年对照组左房内径〔(4.24±0.43)cmvs(3.83±0.22)cm,P<0.05〕及左房容积〔(70.43±12.70)mlvs(46.2±4.91)ml,P<0.05〕增大;二尖瓣峰流速A(cms)在心房颤动自发复律后24h,48h明显降低,7d有所增高,但仍较对照组低〔(45.4±12.37)cms;(56.64±16.24)cms;(65.01±13.58)cmsvs(74.55±5.97)cms,P<0.05〕;老年PAF组自发复律后LAAEF(%)降低,至7d部分恢复,仍较对照组明显降低〔(15.72±5.22)%;(16.42±5.20)%;(18.89±7.70)%vs(34.65±7.83)%,P<0.05〕。结论老年心房颤动患者左房内径和左房容积增大,心房颤动自发复律7d时LAAEF仍降低。由于自发复律后仍存在左房收缩功能障碍,且窦性心?Objective To evaluate the left atrial function after spontaneous cardioversion of atrial fibrillation to sinus rhythm in the elderly. Methods Twenty control elderly patients and 20 patients with nonvalvular disease paroxysmal atrial fibrillation (PAF) were included. Transthoracic echocardiography was used to evaluate the left atrial function 24 hours, 72 hours and 7 days after spontaneous cardioversion to sinus rhythm. Left atrial function was measured by SONOS 5500 ultrasonocardiograph. The left atrial dimensions (LAD), left ventricular dimensions (LVD), left ventricular ejection fraction (LVEF), mitral flow Doppler E velocity, A velocity, and left atrial volume were measured. Results LAD and LA volume increased in PAF 〔(4.24±0.43)cm vs (3.83±0.22)cm, P <0.05 and (70.43±12.70)ml vs (46.2±4.91)ml, P <0.05〕 24 h, 48 h and 7 days after spontaneous cardioversion of atrial fibrillation to sinus rhythm, the A velocity 〔(45.4±12.37) cm/s;(56.64± 16.24) cm/s; (65.01±13.58)cm/s vs (74.55±5.97)cm/s, P <0.05〕 and left atrial active empty fraction (LAAEF,%) 〔(15.72± 5.22);(16.42±5.20);(18.89±7.70) vs (34.65±7.83), P <0.05)〕 were decreased. The atrial function was depressed after spontaneous cardioversion. The left atrial contraction function was still not completely recovered 7 days after cardioversion. Conclusion The internal diameter and volume of left atrium in elderly PAF patients were increased. Seven days after spontaneous cardioversion, the left atrial active ejection fraction (LAAEF) was still decreased. Since left atrial contraction dysfunction still existed after spontaneous cardioversion and the sinus rhythm was difficult to be maintained, the anticoagulative therapy is very important for the elderly PAF patients with increased left atrial volume.

关 键 词：心房颤动 自发复律 老年 心房功能 窦性心律 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]