病因学诊断“心房颤动”患者心脏超声特点及临床应用

Characteristics and clinical application of echocardiography in etiological diagnosis of“atrial fibrillation”

目的探讨病因学诊断“心房颤动”患者的心脏超声特点及临床应用。方法回顾性分析北部战区总医院心血管外科自2012年1月至2019年12月收治的心脏超声诊断为“心房颤动”的患者的临床资料。根据房室瓣反流情况,将693例患者分入4组:A组(n=188)为二尖瓣和/或三尖瓣微量或轻度关闭不全,B组(n=109)仅三尖瓣中度及以上关闭不全,C组(n=127)仅二尖瓣中度及以上关闭不全,D组(n=269)为二尖瓣及三尖瓣均有中度及以上关闭不全。比较4组患者的临床资料,采用单因素和多因素分析法分析心房颤动的影响因素。结果693例患者中,共有男性436例(62.91%);4组男性患者所占比例两两比较,差异均有统计学意义(P<0.05),其中,A组男性比例最高(75.00%),随着房室瓣反流量增加,女性患者比例开始上升。B组患者平均年龄明显高于其他3组,差异有统计学意义(P<0.05)。A、B、C、D组心房仍有收缩患者分别有24、8、2、12例,A组心房仍有收缩患者所占比例高于C、D组,差异有统计学意义(P<0.05)。多因素分析发现,女性心房颤动患者更易出现房室瓣反流;二、三尖瓣瓣环扩张分别是C组和B组患者的独立临床特点;C组患者左室舒张功能明显降低,D组患者右室舒张功能明显降低。结论房室瓣反流的不同类型与年龄无明显内在关系,房室瓣瓣环扩张在心房颤动的发生和发展中发挥重要作用,房室瓣瓣环内径应作为心房颤动患者的常规测量指标;同时,将病因学诊断“心房颤动”纳入心脏超声报告可直接明确诊疗方案,缩短诊疗流程。

Objective To investigate the characteristics and clinical application of echocardiography in the etiological diagnosis of“atrial fibrillation”.Methods A retrospective study was performed on the patients with“atrial fibrillation”diagnosed by echocardiography who were admitted from January 2012 to December 2019.According to the situation of atrioventricular valve regurgitation,693 patients were divided into the 4 groups:Group A(n=188)for mitral and/or trace or mild tricuspid regurgitation,Group B(n=109)only tricuspid moderate or above closing was not complete,Group C(n=127)closed mitral valve only moderate or more was not complete,Group D(n=269)for mitral valve and tricuspid valve were moderate or above closing was not complete.The clinical data of 4 groups of patients were compared,and the influential factors of atrial fibrillation were analyzed by single factor analysis and multi-factor analysis.Results Among the 693 patients,there were 436 males(62.91%).The proportion of male patients in the four groups was pairwise compared,and the difference was statistically significant(P<0.05).Among them,the proportion of male patients in Group A was the highest(75.00%),and the proportion of female patients began to increase with the increase of the back flow of atrioventricular valve.The average age of patients in Group B was significantly higher than that in the other 3 groups(P<0.05).There were 24,8,2 and 12 cases of patients with atrial contraction in Group A,Group B,Group C and Group D,respectively.The proportion of patients with atrial contraction in Group A was higher than that in Group C and Group D(P<0.05).Multi-factor analysis showed that female patients with atrial fibrillation were more likely to have atrioventricular valve reflux,and the dilatation of the second and tricuspid valve rings was an independent clinical feature of patients in Group C and Group B,respectively.Left ventricular diastolic function significantly decreased in Group C and right ventricular diastolic function significantly reduced in Group D.Conclusion Different types of atrioventricular valve regurgitation have no obvious intrinsic relationship with age.Atrioventricular valvular ring dilation play an important role in the occurrence and development of atrial fibrillation.At the same time,the inclusion of aetiological diagnosis of“atrial fibrillation”in the cardiac ultrasound report can directly clarify the treatment plan and shorten the treatment process.