二尖瓣手术同时行射频消融迷宫术对心房颤动患者血流动力学的影响  

Impact of radiofrequency modified Maze procedure combined with mitral vavle surgery on hemodynamics of patients with atrial fibrillation

作　　者：王邵华[1] 王春生[2] 彭寿行[1] 

机构地区：[1]上海交通大学附属第一人民医院胸外科,200080 [2]复旦大学附属中山医院心脏外科

出　　处：《上海医学》2007年第7期493-496,共4页Shanghai Medical Journal

摘　　要：目的评价二尖瓣手术同时行射频(RF)消融迷宫(Maze)术对心房颤动(af)患者血流动力学的影响。方法将2003年1月至2004年10月在复旦大学附属中山医院接受二尖瓣手术同时行RF消融MazeⅢ手术的66例患者作为研究组,选择同期合并术前af但仅行二尖瓣手术的66例作为对照组,两组一般情况、基础疾病的差异均无统计学意义(P值均>0.05)。通过回顾性分析和随访比较两组左房收缩功能、左房室大小、纽约心脏病学会(NYHA)心功能分级和血栓栓塞事件发生率的差异。结果研究组平均随访(14.3±6.5)个月,对照组为(15.7±6.8)个月。两组术后最近一次随访时(>6个月)的左房、左室横径均较术前明显缩小(P值均<0.05),研究组术后左房横径明显小于对照组(P<0.01)。最后一次随访中,研究组NYHA心功能分级≥Ⅱ级者的构成比明显少于对照组(P<0.05),血栓栓塞事件发生率明显低于对照组(P<0.05)。结论二尖瓣手术手术同时行af消融Maze手术可有效改善af患者术后的血流动力学,并使患者从中受益。Objective To evaluate the impact of radiofrequency（RF） modified Maze procedure combined with mitral vavle surgery on hemodynamics of patients with atrial fibrillation. Method From January 2003 and October 2004, 66 patients underwent the radiofrequency modified Maze procedure for atrial fibrillation combined with mitral vavle surgery （Group A）. They were compared to 66 patients with atrial fibrillation who underwent mitral vavle surgery without Maze procedure during the same interval（Group B）. The patients in the two groups were similar in age, gender, preoperative NYHA class, duration of atrial fibrillation, preoperative left atrial dimension（LAD）, and basal diseases. The differences in postoperative hemodynamics, cardiac function and free from thromboembolic events were compared through retrospective analysis and follow-up study. Results Postoperative left atrial contraction transport function had been documented in 74.6 % by Doppler echocardiography in Group A, which was better than that in Group B（P〈0.01 ）. Significant decrease was seen in both LAD and left ventricular dimension（LVD） in both groups（P 〈 0.01 ） more than 6 months after operation and more significant decrease in LAD was found in the study group（P 〈0.01）. At the latest follow-up, the proportion of the patients in NYHA Ⅱ α higher was significantly greater among the Group B（P〈 0. 05）. A significant lower incidence of thromboembolic events was seen in Group A（P 〈0.05）. Conclusion RF modified Maze procedure combined with mitral vavle surgery significantly improves the hemodynamics in patients with atrial fibrillation and benefits these patients.

关 键 词：心房颤动 迷宫手术 射频消融 血流动力学 

分 类 号：R654.2[医药卫生—外科学]