风湿性心脏瓣膜病合并心房颤动单极和双极射频消融的疗效对比  

Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease

作　　者：刘健[1] 王利民[1] 施盛[1] 袁忠祥[1] 

机构地区：[1]上海市第一人民医院心血管外科,上海200080

出　　处：《中国胸心血管外科临床杂志》2017年第3期217-221,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市卫计委面上项目(201440293)

摘　　要：目的对比风湿性心脏瓣膜病瓣膜置换同期单极和双极射频消融的疗效。方法回顾性分析2010~2015年上海市第一人民医院行瓣膜置换术和射频消融迷宫手术的261例风湿性心脏瓣膜病合并心房颤动(房颤)患者的临床资料,根据射频消融方式的不同分为单极消融组[(209例,其中男129例、女80例,年龄(59.6±9.7)岁]和双极消融组[52例,其中男36例、女16例,年龄(58.6±11.2)岁]。比较两组患者基础临床资料、围术期并发症发生率及死亡率、房颤消除率等指标。结果两组围术期死亡率及并发症发生率无明显差异,单极消融组射频消融时间长于双极消融组[(29.7±3.3)min vs.(22.3±7.8)min,P=0.035)],术后1年随访中,两组患者的左房内径均明显减小,双极消融组术后3个月和1年随访时房颤消除率分别为82.0%和80.0%,明显高于单极消融组的66.3%和59.6%(P=0.037和P=0.008)。结论风湿性心脏瓣膜病瓣膜置换同期行房颤消融术是安全有效的,与单极射频消融相比,双极射频消融房颤消除率高,射频消融时间和体外循环时间均有所缩短,具有更好的临床应用价值。Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People＇s Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group （n=209, 129 males, 80 females, aged 59.6±9.7 years） and a bipolar radiofrequency ablation group （n=52, 36 males, 16 females, aged 58.6±11.2 years）. After procedures, clinical factors such as patients＇ basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group （29.7±3.3 minvs. 22.3±7.8 min,P=0.035）. Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up （82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008）. Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.

关 键 词：风湿性心脏瓣膜病 瓣膜置换术 房颤 射频消融术 

分 类 号：R654.2[医药卫生—外科学]