49例双极射频消融改良迷宫手术治疗心脏病合并心房纤颤  

49 cases of dual probe bipolar mode RFA modified maze procedure curing heart disease combined with atrial fibrillation

作　　者：黄击修 刘健[1] 刘勇[1] 林小彬[1] 付建[1] 胡月鹏[1] 

机构地区：[1]简阳市人民医院心外科,四川省641400

出　　处：《中国心血管病研究》2011年第2期136-138,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨心脏手术同期进行双极射频改良迷宫手术（Cox maze Ⅲ）治疗心房颤动（AF）的手术效果,研究术后窦性心律维持率及其与左心房大小的关系.方法 2008年4月至2010年6月心脏病合并AF的患者接受心脏手术,同期行房颤改良双极射频消融手术,比较手术前后心电图前后心电图、超声心动图各项指标及心功能变化.结果 全组无手术死亡,术后低心排除量综合征1例,频发室性早搏并短阵室性心动过速2例.全部患者顺利出院.术后失访1例,1例于术后6个月死于栓塞.47例随访存活者,随访3～29个月,3个月、6个月和1年以上稳定窦性心律分别为36/48（75.0%）、36/40（90.0%）和20/22（90.9%）,心功能（NYHA）Ⅰ级41例、Ⅱ级6例,超声显示左房明显缩小.结论 心脏手术中行Cox maze Ⅲ治疗AF安全有效,临床效果良好.随着术后时间延长,稳定窦性心律逐步增加,左房≤60 mm者窦性心律维持率高于≥60 mm者.Objective To investigate the operation effects of cardiac surgery with dual probe h/polar mode RFA modified maze procedure （Cox maze Ⅲ） curing auricular fibrillation （AF）, and to study the maintenance of sinus rhythm after operation and its relation to the left atrial size. Methods Consecutive cardiac surgery with Cox maze Ⅲ simultaneously cases of heart disease combined with atrial fibrillation from April, 2008 to June, 2010 were enrolled,. The electrocardiogram, all the indicators of ultrasonic cardiogram and heart functions before and after treatment were compared. Results All patients survived and no operative death was noted, 1 had hypo-cardiac output, 2 had FPVC and burst ventricular tachycardia. 1 losted during follow-up, 1 died of embolism 6 months after operation. 47 followed up survived. During the follow-up of 3 to 29 months, stable sinus rhythms （sSR） of 3 months, 6 months and over 1 year were 36/48 （75.0%）, 36/40 （90.0%）, 20/22 （90.9%） respectively. 41 had NYHA I and 6 had NYHA Ⅱ. Sonography showed that left atrium obviously contracted. Conclusion In cardiac surgery, Cox maze ]A is safe and has good clinical effect in curing AF. With the passage of time after operation, stable sinus rhythm is gradually increase, maintenance of sinus rhythm in left atrium ~〈60 mm higher than ≥ 60 mm.

关 键 词：心房颤动 迷宫手术 双极射频消融 心脏直视手术 

分 类 号：R654.2[医药卫生—外科学]