二尖瓣置换术后患者持续性心房颤动心率控制与节律控制的对比分析  

Comparison of rate control and rhythm control in patients with persistent atrial fibrillation after mitraloperation

作　　者：钱峰[1] 傅朝蓬 张泽灵 李莉[1] 

机构地区：[1]解放军第二军医大学长海医院胸心外科,200433 [2]每南边防总队医院心内科

出　　处：《中华心律失常学杂志》2011年第3期218-220,共3页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的研究风湿性心脏病（风心病）二尖瓣置换术后心率控制与节律控制对患者远期预后的影响。方法本试验采用回顾性分析。选择2006年在我院择期行二尖瓣置换术的患者197例，按术后心律情况分为窦性心律组（n=100）和心房颤动（房颤）组（n=97）。收集患者基本资料，以患者手术结束为试验起始时间，随访术后发生脑卒中及心脏性死亡情况，平均随访（2．4±0．5）年。并记录患者术后第7天超声心动图及出院后复查的超声心动图各项参数，两组超声心动图随访时间房颤组为（10．45±7．67）个月，窦性心律组为（10．58±6．33）个月（P=0．90）。结果术后患者超声心动图各项参数的变化（超声心动图末次随访各项参数与术后第7天的各项参数的差值）与组别（即术后心律情况）有关的有：左心房内径、左心室射血分数（LVEF）、三尖瓣反流量。术后的随访结果显示：房颤组左心房内径较窦性心律组明显增加3．811mm，房颤组LVEF值较窦性心律组明显减低0．03，三尖瓣反流量明显增加4．985ml；房颤组心脏性死亡明显多于窦性心律组（8例对0例，P=0．01）。结论风心病二尖瓣置换术后持续性房颤对患者远期预后的影响更大，对于心脏术后房颤应积极予以转复。Objective To investigate the long-term impact of rate control and rhythm control in rheumatic heart disease patients after mitral valve replacement. Methods Retrospective analysis of selected 197 patients with mitral valve surgery at our division in 2006 was performed. All cases were divided into two groups ： sinus rhythm group （ SR, 100 cases ） and atrial fibrillation group （ AF, 97 cases ）. Echocardiography was performed at the 7th day and ten months after surgery. At the time of 2. 4 years follow-up, postoperative stroke and cardiac death were recorded. Result Left atrial diameter （ LAD ） was increased by 3.811 ram, Left ventricular ejection fraction（LVEF） was decreased by 0.03, and tricuspid regurgitation was enhanced by 4. 985 ml in AF group when compared with SR group during postoperative follow-up. There were a total of 8 cardiac death in AF group and none in SR group （P = 0. 01 ）. Conclusion Persistent AF will affect patients＇ long-term prognosis greatly after mitral valve replacement, atrial fibrillation should be returned actively after cardiac surgery.

关 键 词：心房颤动 心脏瓣膜置换术 风湿性心脏病 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]