目的:探索希氏束-浦肯野传导系统起搏[HPCSP,包括希氏束起搏(HBP)和左束支区域起搏(LBBAP)]联合房室结消融治疗心房颤动(房颤)合并心力衰竭(心衰)的有效性及安全性。方法:在PubMed、Cochrane图书馆、Web of Science、Embase、中国知网...目的:探索希氏束-浦肯野传导系统起搏[HPCSP,包括希氏束起搏(HBP)和左束支区域起搏(LBBAP)]联合房室结消融治疗心房颤动(房颤)合并心力衰竭(心衰)的有效性及安全性。方法:在PubMed、Cochrane图书馆、Web of Science、Embase、中国知网、万方数据库、维普网、中华医学期刊全文数据库检索关于HPCSP联合房室结消融治疗房颤合并心衰患者的研究,检索时间为各数据库建库到2024年7月31日。采用纽卡斯尔-渥太华(NOS)量表对纳入的队列研究进行质量评价,使用Cochrane偏倚风险评价方法评估随机对照研究的质量,并用RevMan 5.4、Stata 15.1软件进行Meta分析。结果:共纳入13项研究,共1071例患者。HPCSP联合房室结消融成功率为93.1%。Meta分析结果显示,在有效性方面,与基线相比,随访时患者的左心室舒张末期内径(LVEDD)[均数差(MD)=-3.11,95%CI:-4.16~-2.06,P<0.00001)]及纽约心脏协会(NYHA)心功能分级(MD=-1.36,95%CI:-1.48~-1.24,P<0.00001)明显改善,左心室射血分数(LVEF)(MD=9.86,95%CI:7.02~12.69,P<0.00001)明显提高,房室结消融后,起搏QRS波时限(QRSd)较基线延长(MD=7.83,95%CI:2.79~12.87,P=0.002);在安全性方面,HPCSP术中及随访时的起搏阈值保持稳定(MD=0.07,95%CI:-0.01~0.15,P=0.11),阻抗较围术期明显下降(MD=-78.84,95%CI:-120.21~-37.47,P=0.0002),并发症发生率为7.9%,心衰再住院率为4.5%,死亡率为5.8%。与双心室起搏相比,HPCSP明显缩短起搏QRSd(MD=-39.08,95%CI:-62.35~-15.80,P=0.001),改善随访LVEF(MD=4.38,95%CI:0.37~8.40,P=0.030),二者LVEDD变化(MD=-9.11,95%CI:-19.93~1.72,P=0.100)差异无统计学意义。随访期间,LBBAP起搏阈值低于HBP(MD=0.61,95%CI:0.23~1.00,P=0.002);LBBAP与HBP终点事件发生率差异无统计学意义(RR=1.47,95%CI:0.83~2.60,P=0.190)。结论:HPCSP联合房室结消融治疗房颤合并心衰有效、安全。HPCSP较双心室起搏可更好的促进心电同步并进一步改善患者心功能,LBBAP起搏参数优于HBP。展开更多
The matrix D describing relations of the loops to the nodes in the graph and also the setsof branches based on the independent loops and their matrix Q are defined.The theorem in whichthe product of the loop-node matr...The matrix D describing relations of the loops to the nodes in the graph and also the setsof branches based on the independent loops and their matrix Q are defined.The theorem in whichthe product of the loop-node matrix D multiplied by the incidence matrix A<sub>a</sub> is equal to matrix Qis put forward and proved.The admittance matrix Y<sub>lc</sub> of the sets of the branches is defined and it isassumed that the vector V<sub>lc</sub> of voltage of the sets of branches to be a calculative quantity.The equa-tion of the sets of branches is derived and the analysis method of the sets of branches based on theindependent loops in the electric network is presented.展开更多
文摘目的:探索希氏束-浦肯野传导系统起搏[HPCSP,包括希氏束起搏(HBP)和左束支区域起搏(LBBAP)]联合房室结消融治疗心房颤动(房颤)合并心力衰竭(心衰)的有效性及安全性。方法:在PubMed、Cochrane图书馆、Web of Science、Embase、中国知网、万方数据库、维普网、中华医学期刊全文数据库检索关于HPCSP联合房室结消融治疗房颤合并心衰患者的研究,检索时间为各数据库建库到2024年7月31日。采用纽卡斯尔-渥太华(NOS)量表对纳入的队列研究进行质量评价,使用Cochrane偏倚风险评价方法评估随机对照研究的质量,并用RevMan 5.4、Stata 15.1软件进行Meta分析。结果:共纳入13项研究,共1071例患者。HPCSP联合房室结消融成功率为93.1%。Meta分析结果显示,在有效性方面,与基线相比,随访时患者的左心室舒张末期内径(LVEDD)[均数差(MD)=-3.11,95%CI:-4.16~-2.06,P<0.00001)]及纽约心脏协会(NYHA)心功能分级(MD=-1.36,95%CI:-1.48~-1.24,P<0.00001)明显改善,左心室射血分数(LVEF)(MD=9.86,95%CI:7.02~12.69,P<0.00001)明显提高,房室结消融后,起搏QRS波时限(QRSd)较基线延长(MD=7.83,95%CI:2.79~12.87,P=0.002);在安全性方面,HPCSP术中及随访时的起搏阈值保持稳定(MD=0.07,95%CI:-0.01~0.15,P=0.11),阻抗较围术期明显下降(MD=-78.84,95%CI:-120.21~-37.47,P=0.0002),并发症发生率为7.9%,心衰再住院率为4.5%,死亡率为5.8%。与双心室起搏相比,HPCSP明显缩短起搏QRSd(MD=-39.08,95%CI:-62.35~-15.80,P=0.001),改善随访LVEF(MD=4.38,95%CI:0.37~8.40,P=0.030),二者LVEDD变化(MD=-9.11,95%CI:-19.93~1.72,P=0.100)差异无统计学意义。随访期间,LBBAP起搏阈值低于HBP(MD=0.61,95%CI:0.23~1.00,P=0.002);LBBAP与HBP终点事件发生率差异无统计学意义(RR=1.47,95%CI:0.83~2.60,P=0.190)。结论:HPCSP联合房室结消融治疗房颤合并心衰有效、安全。HPCSP较双心室起搏可更好的促进心电同步并进一步改善患者心功能,LBBAP起搏参数优于HBP。
文摘The matrix D describing relations of the loops to the nodes in the graph and also the setsof branches based on the independent loops and their matrix Q are defined.The theorem in whichthe product of the loop-node matrix D multiplied by the incidence matrix A<sub>a</sub> is equal to matrix Qis put forward and proved.The admittance matrix Y<sub>lc</sub> of the sets of the branches is defined and it isassumed that the vector V<sub>lc</sub> of voltage of the sets of branches to be a calculative quantity.The equa-tion of the sets of branches is derived and the analysis method of the sets of branches based on theindependent loops in the electric network is presented.
