瓣膜置换术中双极射频消融治疗风湿性心脏病合并心房颤动  

The therapeutic effects of bipolar radiofrequency ablation during mitral valve replacement operation for rheumatic valve disease with permanent atrial fibrillation

作　　者：郑理玲[1] 廖崇先[2] 陈宏伟[1] 吴伟平[1] 

机构地区：[1]福建医科大学附属泉州第一医院心外科,泉州市362000 [2]福建医科大学附属协和医院心外科

出　　处：《中国心血管病研究》2012年第1期8-10,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨风湿性心脏瓣膜病合并心房颤动（AF）患者同期行瓣膜替换术及双极射频消融迷宫术的近期手术效果.方法 选取风湿性心脏瓣膜病合并心房颤动患者18例（消融组）,同期行瓣膜替换术及双极射频消融迷宫术治疗心房颤动.18例配对仅行心脏瓣膜替换术而未行双极射频消融迷宫术的患者作为对照组.患者年龄36～65岁,平均53.5岁,房颤持续时间1～10年,平均5年,左心房内径为44～67 mm.比较两组患者的手术治疗结果.结果 消融组18例患者术后窦性心律16例,房颤心律1例,结性心律1例;随访8个月,15例维持窦性心律,3例阵发性房颤心律.对照组13例术中心脏复跳后即为房颤心律,5例心脏复跳后为窦性心律,术后24 h内均转为房颤心律,应用胺碘酮不能持续恢复窦性心律.两组术后左房内径均较术前显著降低（P＜0.01）,消融组术后左房内径小于对照组[（33.06±2.88）mm比（36.16±2.43）mm,P＜0.05].结论 风湿性心脏瓣膜病合并慢性心房颤动患者在行瓣膜替换术的同时行附加的双极射频消融手术疗效良好,安全简便.Objective This study was designed to evaluates the short term effect of using bipolar ra- diofrequency ablation （BPRF） during mitral valve replacement operation for rheumatic valve disease combined with permanent atrial fibrillation （AF）. Methods 36 patients with rheumatic valve disease combined with permanent AF undergoing initial valve replacement were matched assigned to with BPRF procedure （A group, n=18） or without BPRF procedure （B group, n=18 ）. The average age of the patients were 53.5 years （range 36-65）, aver- age duration of AF were 5 years and the left atrial diameter was 44-67 ram. The therapeutic effect was evaluated. Results The AF was disappeared in 16 patients of A group after the procedure. Successful restoration of sinus rhythm has been achieved in 15 patients during the follow-up of 8 months, while one patient had recurrence of AF. Every patients were with AF in B group. The left atrial diameter was smaller in patients in A group with in B group [（33.06±2.88）mm vs. （36.16±2.43）mm, P〈0.05]. Conclusion The luitral valve replacement operation combined with BPRF is a safe and effective treatment for patients suffering from rheumatic valve disease combined with permanent AF.

关 键 词：风湿性心脏病 心房颤动 双极射频消融 二尖瓣置换术 

分 类 号：R654.2[医药卫生—外科学]