心房颤动患者心脏功能变化的研究

摘要

Objective To compare the differences of atria and atrial myocyte structure in patients with atrial fibrillation (AF) and sinus rhythm(SR) .To evaluate the influence of AF on cardiac function .Methods 79 patients without heart failure undergoing car-diopulmonary bypass surgery were divided into the AF group (n=39) and the SR group(n=40) .Echocardiography was performed for analysis of left ventricular end diastolic dimension(LVDd) ,left ventricular end-systolic dimension(LVDs) ,left ventricular poste-rior wall(LVPW) ,interventricular septum(IVS) and left atrial diameter(LAD) .Part of left atrial appendages was taken freshly for HE staining in order to observe atrial tissue structure .Results LVDd ,LVDs ,LVPW and IVS of the AF group were lower than that of the SR group .But LAD of the AF group was higher than the SR group .There was statistical significance in IVS and LAD between the two groups(P<0 .05) ,and there were no significant differences in other aspects (P>0 .05) .Compared with the SR group ,the AF group had thinner myocardial atrophy ,more obvious fibrosis ,smaller nucleus and darker HE staining .Conclusion The incidence of AF was mainly in rheumatic heart disease .The development of AF was mostly accompanied with the enlargement of LAD and the change of atrial tissue structure which showed that AF can reduce cardiac function .%目的：比较心房颤动（AF）与窦性心律患者心房大小和组织结构的变化，探讨AF对心脏功能的影响及其临床意义。方法选取需行体外循环手术无心力衰竭临床表现的患者79例，其中，A F患者（A F组）39例，窦性心律患者（窦性组）40例。术前采用超声心动图检查测量其左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、左心室后壁厚度（LVPW）、室间隔厚度（IVS）及左房的内径（LAD）的变化。术中取新鲜的左心耳组织，石蜡包埋切片，HE染色，观察心肌组织结构的变化。结果 AF组LVDd、LVDs、LVPW、IVS均低于窦性组，而AF组LAD明显大于窦性组，AF组与窦性组IVS和LAD的比较，差异有统计学意义（P＜0．05），其他指标差异无统计学意义（P＞0．05）。与窦性组相比，AF组心肌萎缩变细，纤维化明显，细胞核变小，HE染色变深。结论 AF的原发病中以风湿性心脏病最多见，同时AF的发生多伴有LAD的增大和心肌结构的变化，说明AF使心脏功能发生改变。