铈盐引发丙烯腈在含醇羟基硅胶表面的接枝聚合

将偶联剂γ-(2,3-环氧丙氧基)丙基三甲氧基硅烷(EPPS)键合于硅胶微粒表面, 在酸性催化剂作用下, 键合EPPS的环氧键开环, 产生了醇羟基(HXYG), 形成表面带有醇羟基的改性微粒HXYG-SiO2。使用铈盐与硅胶表面的醇羟基构成氧化还原引发体系, 在硅胶表面实施了丙烯腈的接枝聚合,制备了接枝微粒PAN-SiO2,考察了接枝聚合的影响因素。实验结果表明：在所形成的氧化还原引发体系中,由于初级自由基即引发物种处于硅胶微粒表面, 所制备的接枝微粒PAN-SiO2具有高的接枝度(0.19 g/g), 且单体的整体接枝效率高;引发剂铈盐的浓度对接枝度有较大的影响, 铈盐浓度过大, 将会促进氧化终止过程, 降低接枝度, 适宜的铈盐浓度为5.93×10-3 mol/L;接枝度随硫酸浓度的增大呈现先增大后减小的变化规律, 当H+离子浓度为0.38 mol/L时,PAN的接枝度最高。     

利用接枝微球CPVA-g-PMAA与酮洛芬分子间的氢键相互作用构建结肠定位释药体系

通过表面引发接枝聚合,在交联聚乙烯醇(CPVA)微球表面实施了甲基丙烯酸(MAA)的表面引发接枝聚合,制备了高接枝度的接枝微球CPVA-g-PMAA。利用接枝微球CPVA-g-PMAA与酮洛芬(KPF)主-客体之间的氢键相互作用构建结肠定位释药体系。分析了接枝微球CPVA-g-PMAA对KPF 的吸附(载药)性能与吸附机理,深入研究了载药微球在不同pH介质中的释放行为。实验结果表明,在酸性介质中,受主-客体之间强氢键作用的驱动,接枝微球CPVA-g-PMAA对KPF分子表现出强吸附能力,吸附容量接近10     

茶碱分子表面印迹微球的制备及其体外释药性能

通过分子表面印迹技术,采用铈盐-羟基氧化还原引发体系,以交联聚乙烯醇(CPVA)微球为基质、对苯乙烯磺酸钠(SSS)为功能单体、茶碱(TP)为模板药物分子、N,N′-亚甲基双丙烯酰胺(MBA) 为交联剂,制备了TP分子表面印迹微球MIP-PSSS/CPVA。采用红外光谱测定其结构,扫描电镜观察其表面形貌,静态法考察印迹微球MIP-PSSS/CPVA对TP的结合性能及载药印迹微球的体外释药行为。结果表明：TP分子表面印迹微球MIP-PSSS/CPVA对TP具有较高的识别选择性和结合亲合性,当pH=1时,微球对TP的结合容量达到92 mg/g。该印迹微球在模拟胃液中基本不释药;在模拟小肠液中的第2~6 h,累积释放率仅为21%;而在模拟结肠液中突释,之后持续缓慢地释放,表现出优良的pH敏感和时滞双重型结肠定位释药特性。     

在聚砜膜表面接枝聚甲基丙烯酸及接枝膜对生物碱化合物的吸附特性

首先将聚砜(PSF)氯甲基化,制得氯甲基化聚砜(CMPSF),CMPSF流延成膜后与乙二胺(EDA)反应,制得表面键合有EDA的氨基化膜(AMPSF)。在此基础上,在水溶液体系中构建氨基 过硫酸盐表面引发体系,使甲基丙烯酸(MAA)发生接枝聚合,制得了功能接枝膜PSF-g-PMAA。考察了影响膜接枝过程的主要因素,优化了接枝聚合条件。采用傅里叶红外光谱(FT-IR)、光学显微镜(OM)及称重法对接枝膜PSF-g-PMAA进行了表征。最后研究了功能接枝膜对氧化苦参碱和金雀花碱两种生物碱化合物的吸附特性。结果表明,采用氨基 过硫酸盐表面引发体系,可以顺利地实施MAA在PSF膜表面的接枝聚合,接枝度随氨基化膜AMPSF表面氨基键合量的增大而增大,接枝聚合适宜的温度为50 ℃,溶液中适宜的过硫酸盐用量为单体质量的1.0%。在适宜的条件下可制得PMAA接枝度为4.62 mg/cm2的接枝膜。凭借强静电相互作用和氢键作用的协同作用,功能接枝膜PSF-g-PMAA对生物碱化合物可产生强烈的吸附作用,在中性溶液中,对氧化苦参碱和金雀花碱的吸附容量分别可达277 μg/cm2和331 μg/cm2。     

栓塞用水凝胶微球的制备及其理化性质的评价

目的:研究栓塞用微球的制备方法、理化性质及影响因素.方法:采用反相悬浮聚合法制备出 N-[三(羟甲基)甲基]丙烯酰胺-明胶微球.考查了明胶(10.0～100.0 g/L)、N-[三(羟甲基)甲基]丙烯酰胺单体(33～200 g/L)、交联剂N,N′-亚甲基双丙烯酰胺(3.3～10.0 g/L)、表面活性剂Span 80(0.5～1.8 g/L)和引发剂过硫酸铵(1.0～5.0 g/L)等各因素对微球粒径、吸水率和弹性的影响,采用光学显微镜观察了微球的表面形态,并对微球的红外光谱作了分析.结果:制备的微球圆整、表面光滑;平均粒径随着明胶、N-[三(羟甲基)甲基]丙烯酰胺单体、交联剂质量浓度的增加而变大,随着表面活性剂、引发剂浓度的增加而减少;吸水率随着明胶、交联剂质量浓度的增加而降低,表面活性剂的增加对吸水率的影响不大;弹性随明胶浓度的增加而降低,随单体、交联剂浓度的增加而增加,与表面活性剂、引发剂的关系不大.通过综合考虑粒径、吸水率、弹性各影响因素选择的最后反应条件为明胶10.0 g/L、单体100.0 g/L、交联剂6.7 g/L、表面活性剂0.9 g/L、引发剂3.0 g/L,得到的微球平均粒径约为700.0 μm,吸水率为12.4(g/g),弹性(通过微导管最大粒径)为1 600.0 μm; 红外光谱结果证明单体发生了聚合反应,得到N-[三(羟甲基)甲基]丙烯酰胺-明胶微球.结论:研制出的微球外观圆整、亲水性强、弹性良好,具备用于栓塞治疗的特点.     

构建巯基-AIBN表面引发体系制备接枝微粒PGMA-SiO2及其功能性转变的研究

先使用偶联剂γ-巯丙基三甲氧基硅烷(MPMS) 对微米级硅胶微粒进行了表面改性,然后使改性微粒表面的巯基与溶液中的偶氮二异丁腈(AIBN)构成巯基-AIBN引发体系,引发油溶性单体甲基丙烯酸缩水甘油酯(GMA)在硅胶微粒表面发生接枝聚合,制得了高接枝度(23 g/100 g)的接枝微粒PGMA SiO2。对影响GMA接枝聚合的主要因素进行了考察,对表面引发接枝聚合的机理进行了研究。以对氨基苯磺酸钠为试剂,通过环氧基团的开环反应,对PGMA-SiO2接枝微粒进行了功能化改性,将阴离子基团苯磺酸钠(BSNa)键合于接枝大分子PGMA侧链,制得功能接枝微粒BSNa PGMA SiO2,并初步研究了其功能性。 研究表明,受溶液中的AIBN分解反应的诱导,改性硅胶微粒表面的巯基会发生氢原子转移,在硅胶微粒表面产生硫自由基,使GMA可在硅胶微粒表面有效地发生接枝聚合。接枝聚合适宜的温度为55 ℃,适宜的AIBN用量为单体质量的0.8%。功能接枝微粒BSNa PGMA-SiO2表面携带有高密度的负电荷,对苦参碱和金雀花碱等生物碱分子具有强吸附作用。     

微波聚合制备单分散、超细聚甲基丙烯酸甲酯微球

在微波辐照下,通过甲基丙烯酸甲酯(MMA)的无乳化剂乳液聚合,制备出粒径单分散、超细聚甲基丙烯酸甲酯(PMMA)微球。微波显著缩短聚合诱导期,加快聚合反应,其部分原因是微波加快引发剂过硫酸钾(KPS)的分解。实验证明微波辐照下KPS的表观分解活化能(ED)由128.3kJ/mol降低到106.0kJ/mol。单体浓度是影响PMMA乳液粒子尺寸的主要因素,在[MMA]小于0.3mol/L时,平均粒径随单体浓度提高而线形增加;[MMA]为0.3～1.0mol/L时,平均粒径稳定在约200nm;之后随单体浓度进一步增加,乳液稳定性变差。引发剂浓度增加对平均粒径影响较小,但增大引发剂浓度可显著降低粒径分散度。选取[MMA]为0.23～0.3mol/L、[KPS]为3×10-3～6×10-3mol/L可以得到粒径200nm的单分散微球。以丙酮/水(体积比1/3)为反应介质,可制备出数均粒径45nm的PMMA纳米粒子。在体系中加入3.5×10-3mol/L的Cu2+,可制备出数均粒径67nm、单分散的PMMA纳米粒子。     

二苯并-18-冠-6在交联聚乙烯醇微球表面的固载化

通过氯甲基化反应,将冠醚二苯并-18-冠-6 (DBC)转变为氯甲基化的冠醚(CMDBC),使交联聚乙烯醇(CPVA)微球表面的羟基与CMDBC之间发生亲核取代反应,从而实现冠醚的固载化,制得了固载有冠醚的功能微球DBC-CPVA。在建立了冠醚DBC固载量测定方法(溴百里香酚蓝-固相萃取法) 的基础上,重点研究了主要因素对DBC固载化过程的影响规律。结果表明：反应温度与溶剂性质对DBC在CPVA微球上的固载化反应有较大的影响,在70 ℃极性较强的N,N-二甲基甲酰胺（DMF）溶剂中,可制得冠醚DBC固载量为1.72 mmol/g 的DBCCPVA功能微球。     

海藻酸钠与N-异丙基丙烯酰胺接枝共聚及其温度、pH敏感特性研究

采用单铈盐引发体系制备海藻酸钠／聚N-异丙基丙烯酰胺接枝共聚物(SA-g-PNIPAAM)，考察了引发剂浓度、反应温度、反应时间、单体浓度对接枝率的影响，并利用FTIR、DSC对SA-g—PNIPAAM进行了表征；结果表明，单铈盐引发体系可制备接枝率高的SA-g—PNIPAAM，具有温度、pH敏感特性的SA-g—PNIPAAM可望用于新型温敏／肠溶生物功能材料。     

N,N-二甲基苯胺-苄基氯-醋酸引发甲基丙烯酸甲酯的聚合动力学

N,N-二甲基苯胺(DMA)-苄基氯(BC)-醋酸(HAc)体系,可引发甲基丙烯酸甲酯(MMA)的自由基聚合。聚合速率式为:R_P=K[MMA][DMA]~(1/2)[BC]~(1/2)[HAc]°。HAc起催化作用,明显地降低了体系的活化能E_a。测得E_a=36.8kJ/mol。在相同的反应条件下,该体系的聚合速率较DMA-BC-MMA体系快一个数量级。聚合物的分子量与引发剂浓度的1/2次方成反比,且随反应温度的升高而降低。氧对聚合具有明显而复杂的影响。讨论了该引发体系的引发机理。     

Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

Background  The effects of anxiety and depression on the recurrence of persistent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA) are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown.

Methods  One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA (CPVA group) and 103 treated with anti-arrhythmics drugs (medicine group), were enrolled. The Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS) were assessed before and 12 months after treatment in all patients.

Results  The scores of SAS (40.33±7.90 vs. 49.76±9.52, P <0.01) and SDS (42.33±8.73 vs. 48.17±8.77, P <0.01) decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group (17 patients), the scores of SAS and SDS were significantly lower in the non-recurrent group (26 patients) at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA.

Conclusions  Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF. 

     

Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study ［M/F=109/42, mean age （56.0±11.2） (18-79) years］. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P&lt;0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure ［(27.0±18.0) days vs （14.0±8.1） days, P&lt;0.05］, and presented more recurrent episodes ［(3.50±1.08) times a week vs （2.42±1.11） times a week, P&lt;0.05］. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P&lt;0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place different impact on the delayed cure, more delayed cure is obtained with CPVA approach, and the delayed cure occurs earlier with this approach; the average recurrent episodes before delayed cure are also less frequently detected in CPVA group compared with those in SPVA group.     

Recurrent atrial tachycardia and atrial fribrillation after circumferential pulmonary vein ablation: What's the difference?

Background Recurrent atrial tachyarrhythmia (ATa) after circumferential pulmonary vein ablation (CPVA) includes atrial tachycardia (AT) and atrial fribrillation (AF). However, whether there are some differences in clinical course and mechanisms between the recurrent AT and the recurrent AF remained unclear. This study was conducted to investigate the incidence, mechanism, clinical course of the recurrent AT and AF in patients under CPVA.Methods One hundred and thirty consecutive patients (M/F=95/35) with highly symptomatic and multiple antiarrhythmic drugs (AADs) refractory paroxysmal (n=91) or persistent (n=39) AF were included. The ablation protocol consisted solely of two continuous circular lesions around the ipsilateral pulmonary veins (PV) guided by CARTO system. The endpoint of CPVA is PV isolation. For patients with recurrent ATa within 2 months after the initial procedure, cardioversion with direct current was attempted if the ATa lasted for more than 24 hours. A repeat ablation procedure was performed only for patients with AADs refractory recurrent ATa and at least followed up for 2 months after the initial procedure.Results Within 2 months after the initial procedure, 52 patients (40.0%) had experienced episodes of symptomatic recurrent ATa. Among them, 23 patients (44.2%) with recurred AT alone (AT group), 14 patients (26.9%) with recurred AF alone (AF group), and 15 patients (28.8%) with recurred AT and AF (AT plus AF group). The delayed cure rate (65.2%) in AT group was significant higher than that in AF group (21.4%, P<0.05) and AF plus AT group (26.7%, P<0.05). A repeat ablation was performed in 21 patients, including 6 patients with recurrent AT alone, 8 patients with recurrent AF alone, and 7 patients with recurrent AF plus AT. The mean number of PV gaps was 1.2±0.4 in AT group, which was significantly lower than that in AF group (2.6±0.7, P<0.05) and AF plus AT group (2.0±0.6, P<0.05). Delayed cure rate and number of PV gaps between AF group and AF plus AT group were comparable (P>0.05).Conclusions Present study indicates that recurrent AT and AF after CPVA have the different clinical course and different electrophysiological findings during repeat procedure as follows: ⑴After CPVA, spontaneous resolution of recurrent ATa was mainly found in patients with recurrent AT alone (about two thirds patients). ⑵The type of recurrent ATa after CPVA is associated with the number of PV gaps.     

Pulmonary vein tachycardia after pulmonary vein isolation in patients with atrial fibrillation

Background Pulmonary vein (PV) isolation has been developed to treat patients with atrial fibrillation (AF), and the electrophysiological endpoint of PV isolation is the disappearance or dissociation of pulmonary vein potentials (PVPs). Pulmonary vein tachycardia (PVT) is the dissociated PV rhythm with a rapid rate. However, the characteristics and significance of PVT after pulmonary vein isolation in patients with AF remains unclear. Methods From June 2003 to June 2005, a total of 285 consecutive patients with drug refractory AF were included in this study, and they underwent segmental pulmonary vein ablation (SPVA) or circumferential pulmonary vein ablation (CPVA). PV isolation was the initial endpoint for both approaches with documenting disappearance or dissociation of PVPs. PVT was characterized as dissociated activities within PVs with a circle length (CL) of &lt;300 ms, and was classified into organized PVT or disorganized PVT according to the variance of CL. Systematic follow-up was conducted after initial procedures. Continuous variables were analyzed by Student’s t test and categorical variables were analyzed by chi-square test.Results Three hundred and fifteen PVs were ablated in 85 patients underwent SPVA approach, 400 circular lesions surrounding ipsilateral PVs (including 790 PVs) were produced in the rest of 200 patients received CPVA approach. Electrical isolation was achieved in all of these PVs. Of these, PVPs were abolished in 89.8% (992/1105) of the ablated PVs, dissociated PV rhythms were documented in the rest 10.2 % (113/1105) of the treated PVs. Among the 113 dissociated PV rhythms, 28 met the criteria of PVT with mean CL of (155±43) ms (2 PVTs in 2 patients received SPVA, 26 PVTs in 18 patients underwent CPVA). PVT was more frequently documented in patients underwent CPVA approach [9.0% (18/200) vs 2.3% (2/85), P=0.04]. During the 6-month follow-up, it was indicated that no significant difference existed in AF free rate between patients with PVT and those without PVT (P=0.75). Conclusions PVT dissociated from LA activations can be documented after PV isolation, especially in patients underwent CPVA approach. However, PVT does not affect the follow-up results.     

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system

Background The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.Methods Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group Ⅰ, n=40) and by the CARTO system (group Ⅱ, n=35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins’ (PVs’) ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium （LA）. The endpoint of the procedure was complete PVs isolation. Results Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group Ⅱ were significantly shorter than in group Ⅰ ［(150±23) min and (18±17) min versus (170±34) min and (25±16) min, P=0.03 and 0.04, respectively］. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group Ⅰ and group Ⅱ ［(8±4) min and (16±11) min versus (5±4) min and (14±8) min, respectively］. The fluoroscopic durations for CPVA were (15±5) min in group Ⅰ versus (10±6) min in group Ⅱ (P=0.05), and the CPVA procedural durations were significantly shorter in group Ⅱ than in group Ⅰ ［(18±11) min versus (25±10) min, P=0.04］. AF was terminated by radio frequency delivery in 14 cases (35%) in group Ⅰ versus 5 cases (14%) in group Ⅱ (P=0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group Ⅰ versus 11 cases (31%) in group Ⅱ (P=0.004). During a mean follow-up of 7 months, 32 (80%) cases in group Ⅰ and 24 (69%) cases in group Ⅱ were arrhythmia-free (P=0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group Ⅱ. One case had moderate hemothorax in group Ⅰ. All the complications were cured by proper treatment. No PV stenosis was observed. Conclusions The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.     

Recurrent atrial tachycardia and atrial fribrillation after circumferential pulmonary vein ablation: What’s the difference?

Background Recurrent atrial tachyarrhythmia (ATa) after circumferential pulmonary vein ablation (CPVA) includes atrial tachycardia (AT) and atrial fribrillation (AF). However, whether there are some differences in clinical course and mechanisms between the recurrent AT and the recurrent AF remained unclear. This study was conducted to investigate the incidence, mechanism, clinical course of the recurrent AT and AF in patients under CPVA.Methods One hundred and thirty consecutive patients (M/F=95/35) with highly symptomatic and multiple antiarrhythmic drugs (AADs) refractory paroxysmal (n=91) or persistent (n=39) AF were included. The ablation protocol consisted solely of two continuous circular lesions around the ipsilateral pulmonary veins (PV) guided by CARTO system. The endpoint of CPVA is PV isolation. For patients with recurrent ATa within 2 months after the initial procedure, cardioversion with direct current was attempted if the ATa lasted for more than 24 hours. A repeat ablation procedure was performed only for patients with AADs refractory recurrent ATa and at least followed up for 2 months after the initial procedure.Results Within 2 months after the initial procedure, 52 patients (40.0%) had experienced episodes of symptomatic recurrent ATa. Among them, 23 patients (44.2%) with recurred AT alone (AT group), 14 patients (26.9%) with recurred AF alone (AF group), and 15 patients (28.8%) with recurred AT and AF (AT plus AF group). The delayed cure rate (65.2％) in AT group was significant higher than that in AF group (21.4％, P&lt;0.05) and AF plus AT group (26.7%, P&lt;0.05). A repeat ablation was performed in 21 patients, including 6 patients with recurrent AT alone, 8 patients with recurrent AF alone, and 7 patients with recurrent AF plus AT. The mean number of PV gaps was 1.2±0.4 in AT group, which was significantly lower than that in AF group (2.6±0.7, P&lt;0.05) and AF plus AT group (2.0±0.6, P&lt;0.05). Delayed cure rate and number of PV gaps between AF group and AF plus AT group were comparable (P&gt;0.05).Conclusions Present study indicates that recurrent AT and AF after CPVA have the different clinical course and different electrophysiological findings during repeat procedure as follows: ⑴After CPVA, spontaneous resolution of recurrent ATa was mainly found in patients with recurrent AT alone (about two thirds patients). ⑵The type of recurrent ATa after CPVA is associated with the number of PV gaps. Chin Med J 2005; 118(21):1773-1778     

环肺静脉线性消融治疗慢性心房颤动疗效分析

目的探讨三维标测系统指导下环肺静脉线性消融治疗慢性心房颤动(房颤)的疗效和安全性。方法2004年8月至2005年11月间对连续100例慢性房颤患者进行三维标测系统(CARTO系统或EnSiteNavXTM系统)指导下的环肺静脉线性消融,消融的主要终点为肺静脉电学隔离。随访成功的定义为未服用抗心律失常药物无任何房性心律失常发作至少3个月以上。统计相关变量,分析影响成功率的因素。结果平均随访9·7±5·7个月,累计成功率为70%(70例)。复发患者中峡部消融比例及平均射血分数均低于无房颤复发的患者。主要并发症包括心脏压塞3例(3%)、脑卒中1例(1%)、无症状性肺静脉狭窄2例(2%)。结论三维标测系统指导下环肺静脉线性消融治疗慢性房颤疗效较好,安全性有待进一步提高。     

血浆NT—pro-BNP和左房内径对房颤导管射频消融术后复发的评估价值

目的：探讨术前血浆NT-pro-BNP和术前超声心动图左房内径对环肺静脉消融术治疗房颤术后复发的相关性,以提高房颤射频消融手术的成功率。方法70例行环肺静脉消融术的房颤患者,在术前检测血浆NT-pro-BNP,经胸超声心动图测量左房内径,经食道超声心动图了解有无左房内血栓形成。15例有左房内血栓形成者未行环肺静脉消融术,余下55例均成功行环肺静脉消融术。术后随诊,每月复查心电图,动态心电图了解有无房颤的复发。3月后仍有房颤发生则认为手术失败。成功组39例、失败组16例。结果69%患者NT-pro-BNP高于正常范围。消融失败组NT-pro-BNP明显高于成功组,失败组左房内径明显大于成功组。结论对于NT-pro-BNP明显增高且左房内径又明显增大者行环肺静脉消融术治疗房颤则复发的可能性明显增加,可将术前NT-pro-BNP及左房内径作为房颤术前筛选患者的参考指标。     

心房颤动环肺静脉消融术后早期复发预测因素的临床分析

目的探讨心房颤动（AF）环肺静脉消融术（CPVA）后早期复发预测因素。方法收集2010年1月～2013年10月江苏省徐州市中心医院收治的阵发性AF患者120例,实施CPVA进行治疗,根据术后是否复发分为复发组（38例）和未复发组（82例）,探讨术后早期复发的预测因素。结果经单因素分析显示,高血压、P波离散度、左心房内径、术前及术后NT-proBNP水平以及AF持续时间均与术后复发密切相关（p〈0.05）;经多因素分析显示,P波离散度以及术前NTproBNP是术后复发的预测因素。结论P波离散度以及术前NT—proBNP是CPVA术后复发的预测因素,P波离散度提高能够预测复发,而术前NT—proBNP提高则提示AF易感性增强,亦可预测术后复发。     

房颤患者环肺静脉电隔离术后快速性房性心律失常的再消融治疗效果分析

目的:观察心房颤动患者环肺静脉电隔离术(CPVI)后快速性房性心律失常(ATa)的再消融治疗效果,并探讨其可能的发生机制。方法:64例阵发性房颤患者在初次行CPVI后(3.7±2.4)个月再次行电解剖标测系统指导下ATa标测和消融。结果:共标测到78种ATa,其中48种(61.5%)为局灶性机制,30种(38.5%)折返机制。在折返机制中,12例为普通房扑,18例为左房内折返,其折返环与二尖瓣峡部、左房前壁及原环肺静脉消融线上的传导间隙有关。2例患者因ATa不稳定而无法标测。64例患者中,56例(87.5%)消融即刻成功,8例需要电复律成窦性心律。术后随访13~21个月,平均(16.5±2.9)个月,60例(93.8%)患者不再发生ATa。结论:CPVI术后ATa的机制可为折返性和局灶性,可通过CARTO系统激动顺序标测成功消融治疗。