瓣膜置换同期双极射频消融术对心功能恢复的影响  

Influence of Heart Valve Replacement and Concomitant Bipolar Radiofrequency Ablation on Recovery of Cardiac Function

作　　者：刘泓[1] 肖颖彬[1] 陈林[1] 

机构地区：[1]第三军医大学新桥医院心血管外科,重庆400037

出　　处：《中国胸心血管外科临床杂志》2015年第5期428-433,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技计划支撑项目资助(2011BAI11B19)~~

摘　　要：目的评估瓣膜置换同期行双极射频消融术治疗心房颤动（AF）术后中期心功能恢复情况。方法回顾性分析2011年1-12月新桥医院心血管外科同一手术组收治191例瓣膜疾病合并AF患者的临床资料,其中行单纯瓣膜置换术为对照组（n=93）,男31例、女62例,年龄（48.33±7.55）岁,AF持续时间（4.80±2.03）年;瓣膜置换同期行双极射频消融术为同期消融组（n=98）,男27例、女71例,年龄（46.95±7.70）岁,AF持续时间（5.06±2.26）年。分析患者出院前、术后6个月、术后1年、术后2年心脏超声、心电图及相关并发症情况,并通过来院随访、电话、书信问卷等途径评估心脏功能。结果全组无死亡,同期消融组主动脉阻断时间、体外循环时间、住ICU时间、术后累计引流量高于对照组,差异有统计学意义（P〈0.05）。全组随访2年,术后2年,同期消融组随访85例（86.73%）,发生脑栓塞1例,脑出血2例;对照组随访85例（91.40%）,发生脑栓塞4例,脑出血1例;随访中两组均无死亡、心脏破裂,无安装永久性心脏起搏器患者。同期消融组术后1年、术后2年缩短分数高于对照组（37.18%±5.35%vs.34.72%±6.40%,P=0.007;37.95%±7.99%vs.35.18%±5.15%,P=0.008）。同期消融组术后2年左心室射血分数高于对照组（66.27%±6.99%vs.63.33%±8.14%,P=0.012）。同期消融组术后1年、术后2年患者自觉心功能改善率高于对照组（85.39%vs.72.94%,P=0.005;84.71%vs.68.24%,P=0.005）。结论瓣膜置换同期行双极射频消融术治疗心房颤动能明显改善患者术后中期心功能。Objective To evaluate the mid-term recovery of cardiac function after heart valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation（AF）. Methods Clinical data of 191 patients with heart valve disease and AF in the same surgical team of Xinqiao Hospital from January 2011 Jan to December 2013 was retrospectively analyzed. Heart valve replacement was performed for a control group（n=93）, which includes 31 males and 62 females with their age of 48.33±7.55 years and AF duration of 4.80±2.03 years. Valve replacement and concomitant bipolar radiofrequency ablation was performed for a synchronism ablation group（n=98）, which includes 27 males and 71 females with their age of 46.95±7.70 years and AF duration of 5.06±2.26 years. The echocardiogram, electrocardiogram and complications at hospitalization, 6 months, 1 year and 2 year after operation were analyzed. Results No in-hospital death occurred. There were statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, tricuspid ring, ICU stay, total volume of postoperative drainage between the two groups. All the patients were followed up for 2 years.Two years postoperatively, in the synchronism ablation group, 85 patients（86.73%） were followed up, 1 patient with cerebral embolism, 2 patients with cerebral hemorrhage. In the control group, 85 patients（91.40%） were followed up,4 patients with cerebral embolism, 2 patients with cerebral hemorrhage. There were no death, cardiac rupture, and permanent cardiac pacemaker implantation in the two groups during the follow-up. One year and 2 years postoperative fractional shortening of the synchronism ablation group was significantly higher than those of the control group（37.18%±5.35% vs. 34.72%±6.40%, P=0.007; 37.95%±7.99% vs. 35.18%±5.15%, P=0.008）. One year and 2 years postoperative left ventricular ejection fraction of the synchronism ablation group was significantly higher than that of the control group（66.27%±6.99% vs. 63.33%±8.14%, P=0.0

关 键 词：心房颤动 双极射频消融 瓣膜置换 心脏功能 

分 类 号：R654.2[医药卫生—外科学]