胸部皮肤神经活性监测在心房颤动诊疗中的临床意义  

Clinic effect of monitoring thoracic skin nerve activity in the diagnosis and treatment of atrial fibrillation

作　　者：姜兆磊[1] 蔡捷 王巍 汤敏[1] 马南[1] 刘浩[1] 梅举[1] JIANG Zhao-lei;CAI Jie;WANG Wei;TANG Min;MA Nan;LIU Hao;MEI Ju(Department of Cardiothoraeic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200090

出　　处：《中国心血管病研究》2019年第1期40-43,51,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(81570290、81600264);上海市科委科研计划项目(15411952600);上海申康医院发展中心项目(16CR3087B);上海新华医院院级科研课题(15YJ13);上海青年医师资助培养计划.

摘　　要：目的探讨胸部皮肤神经活性监测在心房颤动诊疗中的临床意义。方法选取2017年3~5月在我科拟接受胸腔镜辅助下房颤微创外科射频消融的孤立性房颤患者36例,其中阵发性房颤20例、持续性房颤16例。在房颤消融术前,应用Powerlab数据采集分析系统,采集、分析房颤患者的胸部皮肤神经活性。比较分析持续性房颤患者与阵发性房颤患者之间胸部皮肤神经活性的差异。结果持续性房颤患者的胸部皮肤神经活性[(1.27±0.27)μV(95%CI 1.16~1.41)]明显高于阵发性房颤患者的胸部皮肤神经活性[(1.00±0.34)μV(95%CI 0.87~1.14)](P=0.013),持续性房颤患者的心室率[(89.44±19.74)μm(95%CI 80.81~99.17)]也明显快于阵发性房颤患者的心室率[(71.25±12.34)bpm(95%CI 66.35~76.36)](P=O.004)。持续性房颤患者的胸部皮肤神经活性与心室率呈明显的正相关(r=0.719,P=0.002);阵发性房颤患者的胸部皮肤神经活性与心室率亦呈明显的正相关(r=0.634,P=0.003)。结论胸部皮肤神经活性可有效用于评估心脏交感神经活性,与心室率变化呈正相关;不同类型房颤,其胸部皮肤神经活性有所不同,持续性房颤的胸部皮肤神经活性明显高于阵发性房颤,表明持续性房颤的自主神经重构可能较阵发性房颤更严重。Objective To study the relationship between thoracic skin nerve activity (SKNA)and atrial fibrillation(AF)and the clinic effect of monitoring SKNA in the diagnosis and treatment of AF.Methods SKNA and electrocardiogram were recorded in 36 lone AF patients (paroxysmal AF:n=20;persistent AF:n=16),who prepared to receive AF ablation.Before AF ablation procedure,SKNA and electrocardiogram were recorded with Powerlab system.The differences of SKNA between paroxysmal AF and persistent AF were compared.Results SKNA of persistent AF [(1.27±0.27)μV (95%CI 1.16-1.41 )]were significantly higher than that of paroxysmal AF [(1.00±0.34)μV (95%CI 0.87-1.14)](P=0.013).Ventricular rate (VR)of persistent AF [(89.44±19.74)bpm (95%CI 80.81-99.17)]were also significantly faster than that of paroxysmal AF [(71.25±12.34)bpm (95%CI 66.35-76.36)](P=0.004).There was a positive correlation (r=0.719,P=0.002)between SKNA and VR in persistent AF patients.Also,there was a positive correlation (r=0.634,P=0.003)between SKNA and VR in paroxysmal AF patients.Conclusion SKNA can be effectively used to evaluate cardiac sympathetic nerve activity,which is positively correlated with VR.For different type of AF,SKNA is different.SKNA of persistent AF were significantly higher than that of paroxysmal AF,indicating that autonomic nerve remodeling of persistent AF is more serious than that of paroxysmal AF.

关 键 词：胸部皮肤神经活性 心房颤动 诊断 治疗 

分 类 号：R654.2[医药卫生—外科学]