左心室室壁瘤所致心律失常的6例外科治疗  

Surgical therapy of arrhythmias with ventricular Aneurysm

作　　者：穆军升[1] 张健群[1] 周帆[2] 黄方炯[1] 牛红星[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,北京100029 [2]北京武警总医院超声科

出　　处：《心肺血管病杂志》2013年第2期190-193,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：第二批北京市卫生系统高层次人才培养基金资助(2011-3-065);朝阳区科委社会发展与城乡一体化促进计划项目基金资助(SF1218)

摘　　要：目的:对左心室室壁瘤合并心律失常的患者进行左心室室壁瘤切除,同时行射频消融心脏手术的结果资料进行临床分析,评价其手术疗效。方法:入选我院2008年1月至2011年5月间,接受左心室室壁瘤合并心律失常的患者进行心脏手术6例。心律失常均为药物无法控制的顽固性心律失常,心电图术前证实。结果:6例患者手术后均痊愈出院,治愈率100%。单纯行左心室室壁瘤切除的同时,2例施行左心室室壁瘤颈部内膜射频消融术,4例施行左心室室壁瘤颈部外膜射频消融术。体外循环时间(100.7±48.6)min,循环阻断时间(67.9±36.1)min。本组病例的术前与术后左心室射血分数分别为(35.3±10.2)%与(51.6±10.4)%,术前和术后相比,差异有统计学意义(P<0.05);术前和术后的左心室舒张末径大小分别为(60.5±4.5)mm与(51.2±5.5)mm,术前和术后相比差异有统计学意义(P<0.01);呼吸机辅助时间为(1.2±0.4)d,ICU时间为(1.5±0.8)d,住院时间为(23.3±10.2)d。心电图恢复窦性心律,无各种心律失常出现。随访5例,随访时间3～14个月,治疗效果良好,心电图显示为窦性心律,无心律失常复发,心脏超声示心功能正常,心功能均达Ⅰ～Ⅱ级,生活质量较术前明显提高。结论:左心室室壁瘤患者进行左心室室壁瘤切除,同时进行射频消融术,使患者摆脱心脏疾病症状,这种心脏手术是安全可行的。Objective：To investigate the effectiveness of radiofrequency ablation technique during cardiac surgery in patients undergoing aneurysmectomy of the left ventricle for the treatment of intractable arrhythmias.Methods： Six patients（5 men,aged from 45 to 67） who underwent cardiac surgery with previous aneurysm of left ventricle and arrhythmias were enrolled from January 2008 to May 2011.The arrhythmias were medically intractable and verified by electrocardiogram before operation.Results： No patient died in the post-operative course.The cure rate was 100% with no recurrence of arrhythmias.Two patients underwent encircling endocardial radiofrequency ablation and 4 cases underwent epicardial surface radiofrequency ablation.Surgical resection of ventricular aneurysm was carried out in all patients at same time.Cardiopulmonary bypass time（CPB） was（100.7±48.6）min,the aortic clamping time was（67.9±36.1）min.The left ventricle ejection fraction before operation and after operation were（35.3±10.2）% and（51.6±10.4）%,respectively（P0.05）;Left ventricular end-diastolic diameter before operation and after operation were（60.5±4.5） mm and（51.2±5.5） mm（P0.01）;The time of ventilation was（1.2±0.4） d,the time in ICU was（1.5±0.8） d,the time for hospitalization was（23.3±10.20） d.Sinus rhythm was identified in all patients by electrocardiogram after operation.None of patients required antiarrhythmic therapy.Five patients were followed up for 3~4 months.No recurrent arrhythmias were found in these patients.Conclusion： Surgical procedure of radiofrequency ablation and aneurysmectomy is effective and safe in patients with arrhythmias refractory to medication.

关 键 词：左心室室壁瘤 心律失常 心脏外科手术 

分 类 号：R54[医药卫生—心血管疾病]