风湿性心脏病瓣膜置换术中单极射频消融术治疗永久性心房纤颤的远期疗效及影响因素分析  

Analysis of Long-term Efficacy in Treating the Permanent Atrial Fibrillation Using Monopolar Radiofrequency Ablation Concomitant Cardiac Valve Replacement with Rheumatic Heart Disease and Its Inl uencing Factors

作　　者：吴玉辉[1] 江蕊[2] 杨林山[1] 常青[1] 王洪强[1] 徐平[1] 李青霞[3] 吴淑芳[1] 

机构地区：[1]青岛大学附属医院心外科,山东青岛266003 [2]青岛大学附属医院手术室,山东青岛266003 [3]青岛大学附属医院器官移植科,山东青岛266003

出　　处：《中国胸心血管外科临床杂志》2015年第2期104-109,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析风湿性心脏病瓣膜置换术中行单极射频消融改良迷宫术治疗永久性心房纤颤（房颤）术后远期疗效及其影响因素。方法回顾性分析2004年10月至2010年12月青岛大学附属医院116例同期行瓣膜置换及单极射频消融术的风湿性心瓣膜病合并永久性房颤患者的临床资料,其中男43例、女73例,年龄（50.5±7.5）岁;收集患者术后即刻、出院时、术后3个月、6个月、1年及随后每年的12导联心电图及超声心动图结果,并且记录术后并发症、心功能及生活质量改善情况等。根据末次随访时心电图结果,将患者分为房颤消除组（窦性心律＋结性心律）与房颤组,其中房颤消除组52例（男16例、女36例）,年龄（48.4±7.3）岁;房颤组50例（男22例、女28例）,年龄（51.9±7.1）岁。分析影响术后远期效果的因素。结果住院期间死亡3例（1例因溶血、急性肾功能不全、高钾血症死亡,1例因急性肾功能不全引发多脏器功能不全死亡,1例因反复室性心动过速、心室颤动致多脏器功能不全死亡）。全组随访3~9年,随访期间死亡3例（1例因瓣周漏于外院行二次手术后死亡,余2例原因不详）,失访8例,共有效随访102例（90.3%）。随访中,房颤组有1例患者出现脑栓塞,1例出现脑出血。单因素分析显示房颤消除组与房颤组在患者年龄、术前房颤病程、左心房内径、体外循环时间及升主动脉阻断时间方面差异均有统计学意义,是影响手术效果的因素;多因素分析显示年龄及术前左心房内径是影响手术效果的危险因素。结论瓣膜置换术中单极射频消融改良迷宫术治疗风湿性心瓣膜病合并永久性房颤远期疗效好,年龄及术前左心房内径是影响手术远期疗效的因素。Objective To analyze the long-term efficacy and its influencing factors in the treatment of the permanent atrial fibrillation（AF） using monopolar radiofrequency ablation during concomitant cardiac valve replacement surgery with rheumatic heart disease. Methods Clinical data of the 116 patients with rheumatic heart disease and permanent AF who underwent modified maze procedure using monopolar radiofrequency ablation and concomitant cardiac valve replacement in the Affiliated Hospital of Qingdao University from October 2004 to December 2010 were collected and retrospectively analyzed, including 43 males and 73 females with their age of 50.5±7.5 years. Electrocardiogram（ECG） with 12-lead and echocardiography data, as well as the related complications, cardiac function and life quality were collected at the time of the immediately after the operation, discharge from hospital, 3 months, 6 months, 1 year postoperatively and every year after the operation. Patients were divided into eliminating group of AF（including sinus rhythm and nodal rhythm） and AF group according to the results of the ECG at the time of the ending follow-up. In the eliminating group of AF, there were 52 patients（16 males, 36 females） with their age of 48.4±7.3 years, and in the AF group, there were 50 patients（22 males, 28 females） with their age of 51.9±7.1 years. Analyzed the difference of the related factors between the two groups using statistical methods and tried to find the factors affecting the long-term clinical efficacy of the operation. Results Three patients died in hospital（one died of the hemolysis, acute renal insufficiency and hyperkalemia. One died of the multiple organ dysfunction syndrome caused by the acute renal insufficiency. And the other one died of the multiple organ dysfunction syndrome caused by the repetitive ventricular tachycardia and ventricular fibrillation on the day of the automatic discharge）. Three patients died during the follow-up（one died after the reoperation because of the periv

关 键 词：风湿性心脏病 心房纤颤 单极射频消融 远期疗效 随访 

分 类 号：R654.2[医药卫生—外科学]