PSVT患者RFA术治疗前后直立倾斜试验结果比较及对心脏自主神经的影响  

Head-up tilt test results before and after RFA for PSVT patients and RFA's influence on cardiac autonomic nerves

作　　者：沈媛媛 王晓东[1] Shen Yuanyuan;Wang Xiaodong(Cardiac Electrophysiology Laboratory,Nanyang Second People's Hospital,Nanyang 473000,China)

机构地区：[1]河南省南阳市第二人民医院心脏电生理实验室,473000

出　　处：《国际医药卫生导报》2021年第17期2647-2651,共5页International Medicine and Health Guidance News

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191464)。

摘　　要：目的通过对阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)患者经射频消融(radiofrequency ablation,RFA)术治疗前后直立倾斜试验(head-up tilt test,HUTT)结果的比较,研究RFA术对心脏自主神经的影响及价值。方法选择南阳市第二人民医院2019年1月至2020年12月收治的PSVT患者78例,男33例,女45例,年龄(47.28±11.53)岁。所有患者均接受RFA术治疗,并在术前1 d、术后第2天行HUTT,记录患者电生理情况、手术成功率及并发症,并比较患者术前1 d、术后第2天HUTT情况。结果在78例患者中,房室结折返性心动过速占56.41%(44/78),房室折返性心动过速占43.59%(34/78),手术即时成功率98.72%(77/78),并发症发生率2.56%(2/78);患者在RFA术前1 d、术后第2天的平卧位、直立位、5 min、10 min、15 min、20 min舒张压对比,差异均无统计学意义[(77.59±12.31)mmHg(1 mmHg=0.133 kPa)、(75.78±13.29)mmHg、(75.39±14.95)mmHg、(76.07±12.31)mmHg、(77.88±13.79)mmHg、(77.46±11.91)mmHg比(76.03±12.11)mmHg、(75.36±11.62)mmHg、(76.42±14.01)mmHg、(76.56±12.35)mmHg、(76.29±13.98)mmHg、(78.01±14.08)mmHg,t=0.798、0.210、0.444、0.248、0.715、0.263,P=0.426、0.834、0.658、0.804、0.476、0.793];RFA术后第2天患者的平卧位、直立位收缩压比术前1 d的低[(122.07±20.58)mmHg、(110.68±16.59)mmHg比(128.29±15.21)mmHg、(117.53±21.87)mmHg,t=2.147、2.204,P=0.033、0.029];患者在RFA术前1 d、术后第2天的5 min、10 min、15 min、20 min收缩压对比,差异均无统计学意义[(115.51±18.36)mmHg、(118.31±17.39)mmHg、(117.32±17.06)mmHg、(120.91±17.62)mmHg比(116.61±17.68)mmHg、(113.79±14.08)mmHg、(116.21±17.59)mmHg、(117.28±16.41)mmHg,均P>0.05];患者在RFA术前1 d、术后第2天的平卧位心率对比,差异无统计学意义(t=0.842,P=0.401);RFA术后第2天患者的直立位、5 min、10 min、15 min、20 min心率比术前1 d的高[(86.38±12.10)次/min、(87.82±10.89)次/min、(86.83±11.40)次/min、(86.49±12.61Objective To study the effect and value of radiofrequency ablation(RFA)on cardiac autonomic nerves by comparing the results of head-up tilt test(HUTT)before and after RFA for patients with paroxysmal supraventricular tachycardia(PSVT).Methods A total of 78 PSVT patients admitted to Nanyang Second People's Hospital from January 2019 to December 2020 were enrolled.Among them,there were 33 males and 45 females.They were(47.28±11.53)years old.All underwent RFA,and underwent HUTT 1 d before and the second day after the surgery.The electrophysiological status,surgical success rate,and complications were recorded.The HUTT results 1 d before and the second day after the surgery were compared.Results Among the 78 patients,the proportions of atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia were 56.41%(44/78)and 43.59%(34/78),respectively.The immediate success rate of the surgery and the incidence of complications were 98.72%(77/78)and 2.56%(2/78),respectively.There were no statistical differences in the diastolic blood pressures of supine position,upright position,5min,10min,15min and 20min between 1 d before and the second day after the surgery[(77.59±12.31)mmHg(1mmHg=0.133 kPa),(75.78±13.29)mmHg,(75.39±14.95)mmHg,(76.07±12.31)mmHg,(77.88±13.79)mmHg,and(77.46±11.91)mmHg vs.(76.03±12.11)mmHg,(75.36±11.62)mmHg,(76.42±14.01)mmHg,(76.56±12.35)mmHg,(76.29±13.98)mmHg,and(78.01±14.08)mmHg;t=0.798,0.210,0.444,0.248,0.715,and 0.263;P=0.426,0.834,0.658,0.804,0.476,and 0.793].The systolic blood pressures of supine and upright positions the second day after RFA were lower than those 1 d before RFA[(122.07±20.58)mmHg and(110.68±16.59)mmHg vs.(128.29±15.21)mmHg and(117.53±21.87)mmHg;t=2.147 and 2.204;P=0.033 and 0.029].There were no statistical differences in the systolic blood pressures of 5,10,15,and 20 minutes between 1 d before and the second day after the surgery[(115.51±18.36)mmHg,(118.31±17.39)mmHg,(117.32±17.06)mmHg,and(120.91±17.62)mmHg vs.(116.61±17.68)mmHg,(113.79�

关 键 词：阵发性室上性心动过速 射频消融术 直立倾斜试验 

分 类 号：R654.2[医药卫生—外科学]