洋地黄类药物对慢性房颤电转复后左房机械功能异常的作用  

Influences of Digitalis on Left Atrial Mechanical Dysfunction after Cardioversion of Chronic Atrial Fibrillation

作　　者：周忠泉[1] 王玉璟[1] 易绪英[1] 马莎[1] 杨沙宁[1] 杨学新[1] 邓士兵 

机构地区：[1]长江大学第一临床医学院荆州市第一人民医院心血管内科,湖北荆州434000

出　　处：《长江大学学报（自然科学版）》2017年第12期8-11,共4页Journal of Yangtze University(Natural Science Edition)

摘　　要：目的:观察洋地黄类药物对慢性房颤电转复后发生心房顿抑患者的左房及左心耳机械功能有无改善作用。方法:在慢性房颤转复后即刻发现有心房顿抑54例患者,被随机分为洋地黄组与对照组。转复后1周内,前者接受洋地黄类药物治疗,后者接受安慰剂治疗。转复前、转复后即刻、转复后1d及转复后1周,分别行经胸壁及经食道心脏超声检查,测量跨二尖瓣血流速度及左心耳血流速度。结果:慢性房颤电转复成功后即刻,洋地黄组及对照组左心耳最大排空速度(LAA-PEV)和左心耳最大充盈速度(LAA-PFV)均降低。1d后,两组的E波(73.0±16.8cm/s vs 77.1±22.8cm/s)、A波(63.0±14.0cm/s vs 51.7±12.6cm/s)、E/A比率(1.7±0.7cm/s vs 1.7±0.8cm/s)、LAA-PEV(23.7±8.4cm/s vs 21.7±9.8cm/s)、LAA-PFV(26.2±9.9cm/s vs 24.4±8.4cm/s)和左心耳排空分数(LAA-EF)(31.4%±9.0%vs 30.2%±10.7%)等指标差异均无统计学意义(P>0.05)。1周后,两组的E波(72.8±16.9cm/s vs 72.0±18.8cm/s)、A波(64.7±16.6cm/s vs 61.0±15.6cm/s)、E/A比率(1.3±0.4 vs 1.5±0.7)、LAA-PEV(40.7±10.0cm/s vs 33.9±12.9cm/s)、LAA-PFV(43.0±14.2cm/s vs 35.3±11.0cm/s)和LAA-EF(42.4%±12.4%vs39.3%±11.3%)等指标差异均无统计学意义(P>0.05)。洋地黄组与对照组左房内自发超声显影发生率在转复后1d为11.5%vs 8.7%,转复后1周为9.5%vs 11.1%(P>0.05),两组差异均无统计学意义(P>0.05)。结论:洋地黄类药物对慢性房颤电转复后左房及左心耳机械功能异常无改善作用,也不能减轻左房内自发超声显影,这可能与洋地黄加重细胞内钙超载和减慢心率作用有关。Objective:To investigate whether administration of digitalis can improve mechanical function of left atrial appendage(LAA)and left atrium prospectively in patients with atrial stunning after cardioversion of chronic atrial fibrillation(AF).Methods:54patients in whom atrial stunning had been observed immediately after cardioversion of chronic AF had been randomly divided into the digitalis group and the control group.Digitalis had been used for the former group,the placebo for the latter for 1 week following cardioversion.Transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)had been performed prior to,immediately following,1day after and 1week after cardioversion to measure transmitral flow velocity and LAA flow velocity.Results:Immediately after successful cardioversion of AF both left atrial appendage peak emptying velocity(LAA-PEV)and peak filling velocity(LAA-PFV)became significantly slower in both the groups.1day after cardioversion,there were no significant differences in transmitral E wave(73.0±16.8cm/s vs 77.1±22.8cm/s,P>0.05),A wave(63.0±14.0cm/s vs 51.7±12.6cm/s,P>0.05),E/A ratio(1.7±0.7 vs 1.7±0.8,P>0.05),LAA-PEV(23.7±8.4cm/s vs 21.7±9.8cm/s,P>0.05),LAA-PFV(26.2±9.9cm/s vs 24.4±8.4cm/s,P>0.05)and LAA-EF(31.4%±9.0%vs 30.2%±10.7%,P>0.05)between 2groups.1week after cardioversion,no significant differences were found in transmitral E wave(72.8±16.9cm/s vs 72.0±18.8cm/s,P>0.05),A wave(64.7±16.6cm/s vs 61.0±15.6cm/s,P>0.05),E/A ratio(1.3±0.4 vs 1.5±0.7,P>0.05),LAA-PEV(40.7±10.0cm/s vs33.9±12.9m/s,P>0.05),LAA-PFV(43.0±14.2cm/s vs 35.3±11.0cm/s,P>0.05)and LAA-EF(42.4%±12.4%vs 39.3%±11.3%,P>0.05)between the two groups.The occurrence rates of spontaneous echo contrast were not significantly different between the digitalis and the control group one day and one week after cardioversion.Conclusion:Digitalis cannot improve mechanical dysfunction of LAA and left atrium following cardioversion of chronic AF.Digitalis also cannot prevent the development of spontaneous echo

关 键 词：洋地黄 心房颤动 电转复 心肌顿抑 

分 类 号：R541.4[医药卫生—心血管疾病]