瓣膜置换同期双极射频消融术后呼吸功能变化研究  

Respiratory function after mitral valve replacement concomitant with bipolar radiofrequency ablation

作　　者：李建[1] 陈林[1] 肖颖彬[1] 陈柏成[1] 马瑞彦[1] 郝嘉[1] 程伟[1] 

机构地区：[1]第三军医大学新桥医院全军心血管外科研究所,重庆400037

出　　处：《第三军医大学学报》2014年第4期391-394,共4页Journal of Third Military Medical University

摘　　要：目的探讨瓣膜置换术同期双极射频消融术后呼吸机支持时间及术后早期恢复情况。方法回顾性分析160例2011年瓣膜病伴慢性心房颤动,病史超过6个月的瓣膜手术病例,根据手术方式分为3组,消融组(MVR+COX):行人工二尖瓣置换同期双极射频消融术75例;二尖瓣置换组(MVR):单纯行二尖瓣置换术42例;双瓣置换组(DVR):行人工主动脉瓣及二尖瓣置换术43例。比较3组术后呼吸机支持时间、动脉血气氧分压(PaO2)、动脉血气氧分压/给氧浓度(PaO2/FiO2)、术后引流量及术后第1、7天胸片结果。用年龄、体质量、体外循环时间、主动脉阻断时间、术前PaO2及手术方式与术后呼吸机支持时间行Logistic回归分析。结果呼吸机支持时间、术后引流量消融组均比MVR组及DVR组多;术后PaO2及PaO2/FiO2较其他组偏低(P<0.05);术后第1天胸片提示肺部感染比例稍高,但第7天胸片检查结果无明显差异;Logistic回归分析显示,手术方式与术后呼吸机支持时间明显相关(P<0.05)。结论瓣膜置换术同期双极射频消融较单纯瓣膜置换术术后早期呼吸功能恢复稍慢,可能与肺损伤有关。Objective To study the ventilator support time and the physical condition after the valve replacement surgery concomitant with bipolar radiofrequency ablation.Methods We divided 160 patients, who suffered from rheumatic heart disease and chronic atrial fibrillation over 6 months, into 3 groups： group MVR＋COX including 75 cases who underwent mitral valve replacement concomitant with bipolar radiofrequency ablation, group MVR including 42 cases who underwent mitral valve replacement, and group DVR including 43 cases who underwent aortic and mitral valve replacement. The ventilator support time, partial pressure of oxygen （PaO2）, PaO2/FiO2 and postoperative drainage after surgery were recorded. The chest radiographs in the first and the 7th days after surgery were assessed. Age, weight, duration of on pump time, aorta cross clamping time and preoperative PaO2 were analyzed.Results Compared with groups MVR and DVR, group MVR＋COX showed longer ventilator support time, more postoperative drainage, and lower postoperative PaO2 or PaO2/FiO2 （P〈0.05）. According to the chest radiographs, the proportion for lung infection is slightly higher in group MVR＋COX at the first day, but no significant difference was observed at the 7th day. Analysis of logistic regression showed that the postoperative time of mechanical ventilation was significantly correlated with the surgical procedure （P〈0.05）.Conclusion The postoperative respiratory function after mitral valve replacement concomitant with bipolar radiofrequency ablation recovers more slowly than other groups without bipolar radiofrequency ablation, possibly resulted from lung injury.

关 键 词：心房颤动 双极射频消融术 瓣膜置换术 呼吸功能 急性肺损伤 

分 类 号：R332[医药卫生—人体生理学] R540.46[医药卫生—基础医学]