递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

单环消融术式用于下肺静脉共干患者肺静脉隔离的临床经验

目的对侧肺静脉共干是罕见的肺静脉解剖变异。心房颤动(房颤)患者进行肺静脉隔离应根据患者肺静脉解剖特点制定个体化手术策略。本研究探讨了武汉亚洲心脏病医院心内科在下肺静脉共干的患者中采用盒式单环消融进行肺静脉隔离的安全性及可行性。方法入选2018年1月至11月在武汉亚洲心脏病医院心内科住院的有房颤消融适应证、左右下肺静脉共干并行房颤导管消融手术患者5例,进行回顾性观察性研究。所有患者行房间隔穿刺将冷盐水灌注消融导管送至左心房,在三维标测系统指导下,以功率模式25~35 W,43℃,流速30 ml/min行盒式消融肺静脉单环隔离。记录患者的一般信息及术中资料,包括手术并发症、即刻手术效果、手术时间、X线曝光时间及曝光量,术后1、3、6个月随访患者症状、心电资料并记录随访期内并发症。结果阵发性房颤4例,持续性房颤1例,CHA2DS2-VASC评分为3.8±1.8,HAS-BLED评分为1.8±0.6;双侧下肺静脉共干左右缘内径(32.7±1.71)mm,上下缘内径(25.7±4.50)mm,呈椭圆形。经过消融5例患者均达到双侧肺静脉完全电隔离,即刻消融成功率为100%,无并发症,手术时间82~188(141.8±33.8)min,X线曝光时间15~46(25.8±13.1)min,X线曝光量277~654(439.6±144.7)mGy。随访6~10个月,均维持窦性心律。结论对于下肺静脉共干的房颤患者,采用盒式消融单环隔离肺静脉,具有较好的安全性、可行性及有效性。     

肠结核38例手术治疗分析

目的：探讨肠结核的手术治疗时机及方法。方法：回顾性分析38例肠结核患者的手术方法与效果。结果：38例肠结核患者分别行小肠部分切除、右半结肠切除、肠粘连松解、肠造口等手术，治愈36例，死亡2例。结论：术前认真评估病情，选择合适的手术时机及正确的手术方法，是成功治愈肠结核的关键。     

永久起搏器术后再发晕厥20例病因分析

目的 探讨永久起搏器术后再发晕厥的因为.方法 回顾性分析1050例永久起搏器术后随访期间再发晕厥的20例患者的临床资料.通过电话随访、常规检查、起搏器程控、动态心电图、持续心电监护、肺血管计算机断层扫描、冠状动脉造影、倾斜试验等检查.结果 平均随访(47±31)个月,共有20例患者发生晕厥.明确病因者17例,其中室性心动过速、心室颤动相关的晕厥患者9例.血管迷走性晕厥3例,直立性低血压2例,起搏器相关2例,肺栓塞1例.病因不明者3例.结论 永久起搏器术后再发晕厥因为复杂,排除起搏器功能障碍后应考虑室性心动过速、心室颤动、血管迷走性晕厥、直立性低血压、肺栓塞等病因.     

双源256排CT和食管超声的联合应用对心房颤动患者左心房/左心耳血栓的检测价值

目的：比较双源256排CT(MDCT)和食管超声(TEE)对左心房/左心耳血栓检出的准确性比较。方法：拟行导管消融术的房颤患者1178例,术前48小时内同一天行MDCT和TEE检查,必要时复查TEE,及再次MDCT阅片。评价MDCT和TEE的准确性。结果：经TEE检测出有血栓者为186例,其中假阳性2例。经MDCT检测出有血栓者176例,无假阳性,假阴性8例（1%占）,MDC的敏感性94.6%,特异性100%,阳性预测值100%,阴性预测值99%。两种检测方法的Kappa值为0.961（P＜0.05）。结论：MDCT不能完全取代食管超声作为检测左心房/左心耳血栓的手段。术前常规同时行MDCT和TEE,能提高左心房/左心耳血栓诊断的准确性。     

中西医结合治疗小儿过敏性紫癜肾炎临床观察

我科于1994年至2002年共收治过敏性紫癜肾炎患儿18例。均符合上海儿科学会肾脏专业组提出的诊断标准(草案)…。男12例，女6例，年龄6～13岁。     

洋地黄加合贝爽治疗老年心衰伴快心室率房颤临床观察

临床上，对慢性充血性心力衰竭（CHF）伴快心室率房颤患者通常采用最佳剂量的洋地黄是治疗。但是，单用洋地黄治疗，部分患者心室率不能满意控制，影响疗效，而且往往很难掌握剂量，容易造成中毒或剂量不足。近年来，采用合贝爽（地尔硫革缓释胶囊）加洋地黄治疗此类疾病，取得比较满意的疗效。现将老年心衰伴快心室率房颤患者单用洋地黄治疗不能满意时加用合贝爽的疗效及安全性报告如下。