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目的:研究经食道超声心动图(TEE)评估特发性房颤左心房左心耳的临床价值。方法:选择自2015年1月到2016年8月在医院接受诊治的特发性房颤患者100例纳入本次研究,阵发性房颤92例,记为阵发性房颤组;持续性房颤8例,记为持续性房颤组。另选同期在医院进行健康体检的心功能正常志愿者90例作为对照组。利用TEE对受试者进行检查,对比房颤组与对照组的左心房及左心耳参数,是否含有自发性显影(LASEC)的房颤患者的左心房及左心耳参数,利用TEE分析对房颤患者的预后情况。结果:阵发性房颤组左心房的前后径和左右径,左心耳血流最大的排空速度(Lev)均明显小于对照组,左心耳的面积变化率及最大的充盈速度(Lfv)均明显大于对照组,差异有统计学意义(P<0.05)。持续性房颤组左心房的前后径和左右径均明显大于对照组,左心耳的面积变化率、Lev及Lfv均明显小于对照组,差异有统计学意义(P<0.05)。阵发性房颤组左心房的前后径和左右径均明显小于持续性房颤组,左心耳的面积变化率、Lev及Lfv均明显大于持续性房颤组,差异有统计学意义(P<0.05)。有LASEC者左心房的前后径和左右径均明显大于无LASEC者,左心耳的面积变化率、Lev及Lfv均明显小于无LASEC者,差异有统计学意义(P<0.05)。100例房颤患者中发现34例LASEC,占34.00%,其中有18例患者合并有左心耳血栓,占18.00%。总计有66例患者接受导管射频消融疗法,占66.00%,均未在术中及术后7d内出现血栓及栓塞并发症。结论:利用TEE对特发性房颤的患者左心房及左心耳进行评估,有利于更好的辅助患者的临床治疗,值得重视。
Objective: To study the clinical value of transesophageal echocardiography (TEE) in assessing the left atrial appendage in patients with idiopathic atrial fibrillation. Methods: A total of 100 patients with idiopathic atrial fibrillation who were admitted to the hospital from January 2015 to August 2016 were enrolled in this study. 92 cases of paroxysmal atrial fibrillation were recorded as paroxysmal atrial fibrillation group. Persistent Atrial fibrillation in 8 cases, recorded as persistent atrial fibrillation group. In the same period, 90 normal volunteers with healthy physical examination in hospital were selected as control group. Subjects were examined with TEE to compare left and right atrial appendage parameters in patients with and without atrial fibrillation (AF) with left atrial appendage and left atrial appendage in patients with atrial fibrillation of spontaneous development (LASEC) The patient’s prognosis. Results: The left ventricular anterior and posterior diameter and left and right diameter of the paroxysmal atrial fibrillation group, the largest left atrial appendage flow velocity (Lev) were significantly less than the control group, the left atrial appendage area change rate and the maximum filling rate (Lfv) Significantly higher than the control group, the difference was statistically significant (P <0.05). The anteroposterior diameter and left and right diameter of left atrium in patients with persistent AF were significantly higher than those in control group. The changes of area of left atrial appendage, Lev and Lfv were significantly lower than those in control group (P <0.05). The anteroposterior diameter and left and right diameters of left atrium in patients with paroxysmal atrial fibrillation were significantly lower than those in patients with persistent atrial fibrillation and left atrial appendage. Lev and Lfv were significantly higher than those in patients with persistent atrial fibrillation (P < 0.05). LASEC with left atrial anterior and posterior diameter and left and right diameter were significantly greater than those without LASEC, left atrial appendage area change rate, Lev and Lfv were significantly less than those without LASEC, the difference was statistically significant (P <0.05). 34 cases of LASEC were found in 100 cases of atrial fibrillation, accounting for 34.00%. Among them, 18 cases had left atrial appendage thrombus, accounting for 18.00%. A total of 66 patients underwent radiofrequency catheter ablation, accounting for 66.00%. Neither thromboembolic complications nor intraoperative and postoperative 7th days occurred. Conclusion: The assessment of left atrium and left atrial appendage in patients with idiopathic atrial fibrillation by TEE is helpful to better assist the clinical treatment of patients and deserves attention.