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81.
射频导管消融治疗室上性心动过速对心率变异性的影响 总被引:1,自引:0,他引:1
目的:探讨射频导管消融对心脏自主神经系统功能的影响。方法:对53例室上性心动过速患者采用时域、频域法对比分析射频导管消融前后心率变异性。结果:射频导管消融术后平均心率、最小心率、低频与高频的比值上升,24小时平均心率的标准差,心率变异性指数、变异系数、24小时RR间期直方图1/2高度时的宽度、24小时RR间期直方图1/10高度时的宽度、总频谱,低频成份和高频成份均降低。结论:射频导管消融术后迷走神经和交感神经张力均降低,但主要影响的是迷走神经张力,从而表现为心率变异性的降低。 相似文献
82.
目的 探讨Carto 3三维电生理导航系统指导消融频发性室性早搏(PVC)的临床疗效,以及射频消融术(RFCA)前后血浆氨基末端B型利钠肽(NT-pro BNP)、心脏结构功能的变化。方法 选取2011年至2013年47例频发室性早搏患者行射频消融治疗的患者为病例组,根据标测系统的不同,分为传统组(n=17)和三维组(n=30)。观察比较两组手术时间、X线曝光时间、放电次数及手术即刻成功率、远期成功率。同时监测所有病例行导管消融前及消融3个月后的NT-pro BNP、左室射血分数(LVEF)及左室舒张末期内径(LVEDd)值,另选取51例健康体检者为对照组。结果 三维组在手术时间、X线曝光时间、消融放电次数上明显优于传统组,且差异有统计学意义(P<0.05)。两组即刻成功率(82.35% vs 93.33%)、远期成功率(76.47% vs 86.67%)相近,差异无统计学意义(P>0.05)。对照组、病例组术前、病例组术后3个月NT-pro BNP浓度、LVEDd以及LVEF值比较,差异均无统计学意义(P>0.05)。结论 较二维影像,在Carto 3三维电生理导航系统下行射频消融治疗频发性室性早搏具有较高的即刻及远期成功率,且安全、有效。 相似文献
83.
Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10–15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician''s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. 相似文献
84.
J. Wong J. Vohra W. Chan S. Sathe R. Hall H. Mond D. Hunt 《Internal medicine journal》1994,24(1):9-14
Background: Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients. Methods: RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system. Results: The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers. Conclusions: In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate. 相似文献
85.
Thomas C. Crawford Alan Wimmer Sujoya Dey Nagib Chalfoun Darryl Wells Jean-Francois Sarrazin Michael Kuhne Melissa Frederick Krit Jongnarangsin Eric Good Aman Chugh Frank Bogun Frank Pelosi Jr. Fred Morady Hakan Oral 《Journal of interventional cardiac electrophysiology》2008,21(1):27-33
Background A better understanding of the mechanisms of recurrent atrial fibrillation (AF) after radiofrequency ablation of complex, fractionated
atrial electrograms (CFAEs) may be helpful for refining AF ablation strategies.
Methods and results Electrogram-guided ablation (EGA) was repeated in 30 consecutive patients (mean age = 59 ± 8 years) for recurrent paroxysmal
AF, 10 ± 4 months after the first ablation. During the first procedure, CFAEs were targeted without isolating all pulmonary
veins (PVs). During repeat ablation, all PVs and the superior vena cava (SVC) were mapped with a circular catheter and the
left atrium was mapped for CFAEs. EGA was performed until AF was rendered noninducible or all identified CFAEs were eliminated.
During repeat ablation, ≥1 PV tachycardia was found in 83 PVs in 29 of the 30 patients (97%). Among these 83 PVs, 63 (76%)
had not been completely isolated previously. During repeat ablation, drivers originating in a PV or PV antrum were identified
only after infusion of isoproterenol (20 μg/min) in 12 patients (40%). At 9 ± 4 months of follow-up after the repeat ablation
procedure, 21 of the 30 patients (70%) were free from recurrent AF and flutter without antiarrhythmic drugs.
Conclusions Recurrence of AF after EGA is usually due to PV tachycardias. Therefore, it may be preferable to systematically map and isolate
all PVs during the first procedure. High-dose isoproterenol may be helpful to identify AF drivers. 相似文献
86.
目的观察右美托咪定复合瑞芬太尼用于软组织射频热凝+拨针治疗的临床效果。方法选择行软组织射频热凝+拨针治疗的患者60例,依麻醉方式分为咪达唑仑复合瑞芬太尼组(A组)和右美托咪定复合瑞芬太尼组(B组),每组各30例。记录给药前(T0)、给药后5 min(T1)、10 min(T2)、30 min(T3)、50 min(T4)各时点心率(HR),指脉氧饱和度(SPO2),无创平均动脉压(MAP),呼吸频率(RR),手术时间,苏醒时间,瑞芬太尼的总用量,麻醉后不良反应及并发症,患者苏醒即刻视觉疼痛评分(VAS)。结果两组RR、SPO2、手术时间、苏醒时间无差异性;与T0相比,两组T1时点的RR、HR、MAP均下降(P<0.05);与A组相比,B组MAP、HR下降(P<0.05),不良反应发生率,瑞芬太尼总用量B组少于A组(P<0.05),患者苏醒即刻视觉疼痛评分(VAS)B组低于A组(P<0.05)。结论右美托咪定复合瑞芬太尼用于软组织射频热凝+拨针治疗,是一种安全有效的清醒镇静镇痛方法,值得临床推广。 相似文献
87.
目的 探讨食管内镜下射频消融术(radiofrequency ablation,RFA)后患者发热的独立危险因素。方法 2016年1月—2021年4月,因早期食管癌就诊于长海医院消化内科,且病变范围超过食管3/4环周的51例病例纳入病例对照研究。患者均行RFA治疗,按术后是否发热分成发热组(n=15)和未发热组(n=36),主要收集患者一般情况、消化道肿瘤家族史、病变长度、病变范围、消融能量和消融次数用于单因素分析,其中P<0.1的变量再进一步纳入多因素Logistic回归分析探究RFA术后发热的独立危险因素。结果 单因素分析发现,病变长度(t=-3.89,P<0.001)、病变范围(χ2=11.52,P=0.001)和消融能量(P=0.001)在2组间差异有统计学意义。Pearson相关性显示,病变长度与病变环周长度存在明显正相关(r=0.71,P<0.001),而病变范围由病变环周长度决定,因此最终将病变长度和消融能量这两个变量纳入Logistic回归方程。Logistic回归分析结果显示,食管病变长度每增加1 cm,患者发生RFA术后发热的风险是前者的1.21倍(95%CI:1.01~1.43,P=0.037);术中使用12 J消融能量者,发生RFA术后发热的风险是使用10 J消融能量者的0.43倍(95%CI:0.22~0.85,P=0.015)。结论 病变长度和消融能量是导致食管RFA术后发热的独立危险因素。长节段早期食管癌者更易发生RFA术后发热,术中使用低消融能量者更易发生RFA术后发热。 相似文献
88.
心腔内单极电图旁道定位和消融靶点的图形特征 总被引:1,自引:0,他引:1
采用冠状窦和二尖瓣环单极记录标测左侧显性旁道和确定消融靶点指导射频消融治疗20例预激综合征。同步记录多部位冠状窦单极电图均清楚显示房波(UP)和室波(UR),其旁道定位点表现为 UP 降支和 UR 起始几乎融合构成特征性的复合波——PQS 波,而远离旁道的单极电图显示 UP 和 UR 分离构成 P—QS 或 P—rS 波。二尖瓣环单极记录时其图形变化类同冠状窦。比较冠状窦标测点和二尖瓣环单极电图的图形特征能迅速、直观地确定消融靶点。 相似文献
89.
目的研究不完全射频消融(RFA)治疗对兔VX2肝癌模MMP-9蛋白表达的影响。 方法建立新西兰白兔的VX2肝癌模型,将30只兔VX2肝癌模型分为2组,即对照组和实验组,每组15只,对照组只做开关腹,而不进行RFA;实验组进行开腹消融,消融范围为肿瘤组织的75%;在实验组中设立RFA后快速进展亚组,定义为实验结束时肿瘤的倍增率大于对照组。对比其RFA后的VX2肝癌的体积变化、残留VX2肝癌基质金属蛋白酶-9(MMP-9)的表达情况。 结果对照组和实验组治疗后肿瘤体积分别为(7 862±1 304)mm3和(6 996±709)mm3,肿瘤的倍增率分别为(291±49)和(232±16),差异有统计学意义(P < 0.05)。对照组和实验组MMP-9阳性表达率为52.1%和46.3%,差异均有统计学意义(P < 0.05);实验组中3只实验兔肿瘤倍增率及MMP-9表达率明显高于实验组,属于RF后快速进展亚组,差异有统计学意义(P < 0.05)。 结论部分性消融对大多数肝细胞癌具有一定疗效,但对于少数肿瘤可能加速其生长,而MMP-9的过表达可能是促进残留癌快速进展的原因。 相似文献
90.