二尖瓣病变合并巨大左心房与慢性房颤的外科治疗  

Surgical Treatment of Chronic Atrial Fibrillation and Giant Left Atrium Associated with Mitral Valve Disease

作　　者：许国安[1] 周亚军[1] 徐靖[1] 方向明[1] 徐军[1] 邓武昌[1] 

机构地区：[1]中国人民解放军第九四医院心胸外科,南昌330002

出　　处：《江西医学院学报》2008年第4期74-76,79,共4页Acta Academiae Medicinae Jiangxi

摘　　要：目的评价在二尖瓣置换术同期行改良迷宫术和左房折叠术(LAP)治疗巨大左心房慢性房颤(AF)的临床效果。方法40例左心房容积指数≥55 mL/m2的二尖瓣病变合并慢性AF患者,实施二尖瓣置换术与改良迷宫术,改良迷宫术以Ⅲ型迷宫术为基础进行改良。其中同期加行左房折叠术(LAP组)20例,未加行LAP术的20例为对照组。应用心电图及超声心动图观察手术前后心电活动、心功能、左心房容积指数(LAVI)、左室射血分数(LVEF)的变化。随访1年。结果对照组和LAP组恢复并维持窦性心律分别占55%和85%(P<0.01)、心功能改善级别分别为1.06±0.63和2.01±0.66(P<0.01)、手术后LAVI分别为52.25±14.02和39.98±9.05(P<0.01)、LAEF分别为(55.67±5.33)%和(64.01±7.15)%(P<0.01)。结论对合并巨大左心房的风湿性二尖瓣病变慢性AF患者,实施二尖瓣置换术和改良迷宫术同期加行左房折叠术,更能有效消除AF,长期维持窦律,进一步改善左心房、心室主动收缩功能,疗效确切。Objective To evaluate the benefits of modified maze procedure and left atrial plication （LAP） during mitral valvular replacement in patients with chronic atrial fibrillation and giant left atrium associated with mitral valve disease. Methods Forty patients with chronic atrial fibrillation and giant left atrium（left atrial volume index over 55 mL/m^2）associated with mitral valve disease were treated by modified maze procedure and mitral valvular replacement. Among them,20 patients underwent LAP at the same time （LAP group）. Cox Ⅲ maze procedure was modified in four aspects. The patient＇s changes of heart electricity activity and NYHA were observed by Electrocardiogram and Echocardiogram in all patients, and the follow-up study was made for 12 months. Results The rate of restoration to sinus rhythm was higher in LAP group than that in the control group （85% vs 55%,P〈0.01）. The improvement of the NYHA classes was greater in LAP group than that in the control group （2.01±0.66 和 1.06±0.63,P〈0.01）. The Left atrial volume index（LAVI） was smaller in LAP group than that in the control group （39.98±9.05 vs 52.25±14.02,P〈0.01）. The left ventricular ejection fraction was higher in LAP group than that in the control group [（64.01±7. 15）% vs （55.67±5.33）% ,P〈0.01]. Conclusion For the patients with chronic atrial fibrillation and giant left atrium associated with mitral valve disease, LAP combined modified maze procedure during mitral valvular replacement is the effective treatment in treating chronic atrial fibrillation, maintaining sinus rhythm and im- proving atrial and ventricular contraction functions.

关 键 词：心房颤动 慢性 巨大左心房 二尖瓣病变 外科手术 迷宫手术 

分 类 号：R654.2[医药卫生—外科学]