迷宫Ⅲ手术治疗瓣膜病合并心房颤动的围术期处理  

Perioperative treatment of Cox-maze Ⅲ procedure for atrial fibrillation associated with valvular heart disease

作　　者：韩劲松[1] 王辉山[1] 汪曾炜[1] 尹宗涛[1] 韩宏光[1] 陈朝辉[1] 

机构地区：[1]沈阳军区总医院心血管外科,辽宁省沈阳市110016

出　　处：《中国心血管病研究》2017年第1期23-26,共4页Chinese Journal of Cardiovascular Research

基　　金：2014年辽宁省自然科学基金项目（项目编号：2014020065）;2015年辽宁省自然科学基金项目（项目编号：2015020407）

摘　　要：目的 总结迷宫Ⅲ手术治疗瓣膜病合并心房颤动（房颤）术后处理的经验.方法 2013年10月至2016年5月间,我院施行迷宫Ⅲ手术治疗瓣膜病合并房颤患者178例.同期行二尖瓣置换术95例、二尖瓣成形术28例、主动脉瓣置换5例、主动脉瓣和二尖瓣置换术50例.结果 死亡1例（0.56％）,因左心室破裂修补成功4d后多脏器衰竭死亡.主动脉阻断时间（102.24±22.07）min,体外循环时间（192.97±32.21）min,ICU停留时间（35.55±17.62）h,术后住院时间（15.10±3.33）d.出现二次开胸止血4例（2.25％）、新发脑梗死2例（1.12％）、低心排血量综合征5例（2.81％）.应用临时起搏器136例（76.41％）,行同步电复律14例（7.87％）,无应用永久起搏器的患者.出院时窦性心律170例（96.05％,170/177）、房颤7例（3.95％,7/177）,NYHA心功能Ⅰ级158例（89.27％）、Ⅱ级19例（10.73％）.超声心动图提示左心室和左心房直径均较术前明显缩小（P＜0.01）,左心室射血分数较术前明显增加（P＜0.01）.出现跨二尖瓣A峰142例（80.23％,142/177）,出现跨三尖瓣A峰152例（85.88％,152/177）.结论 系统训练、合理选择患者、恰当的手术处理、术后积极防治心律失常是迷宫Ⅲ手术围术期处理的关键.Objective To summarize the experience of perioperative treatment of Cox-maze m procedure for atrial fibrillation （AF） associated with valvular heart disease. Methods From October 2013 to May 2016, 178 patients received Cox-maze Ⅲ procedure for AF in our hospital. The concomitant surgery included mitral valve re- placement in 95, mitral valvuloplasty in 28, aortic valve replacement in 5, aortic and mitral valve replacement in 50. Results One death （0.56%） died of multi-organ failure due to left ventrieular rupture 4 days after being suc- cessfully repaired. The mean aortic-clamp time was （102.24±22.07）min, and the mean cardiopulmonary bypass was （192.97±32.21）min. The average ICU stay time was （35.55±17.62）h, and the postoperative hospital stay time was （15.10±3.33）d. Secondary-thoracotomy bleeding occurred in 4 patients （2.25%）, new-set strokes in 2 （1.12%）, and low-output syndrome in 5（2.81% ）. 136 patients（76.41%） received temporary pacemaker implanta- tion but no one required permanent pacemaker, and 14 patients received cardioversion. At discharge, 170 patients （96.05%, 170/177） were in sinus rhythm and 7（3.95%, 7/177） in AF. NYHA functional class at discharge were 158 （89.27%, 158/177） at I and 19 （10.73%, 19/177） at 11. Echocardiography showed there were significant differences in the left atrial and left ventricular diameter, and left ventricular ejection fraction between before and after surgery（P〈0.01 ）. The proportions of mitral and tricuspid valve peak A-waves were 80.23%（ 142/177 ） and85.88%（152/177） respectively. Conclusion The key to perioperative treatment of Cox-maze Ⅲ procedure are to be well-trained, to make a right choice of patients, to adopt appropriate procedures, to prevent and treat postoper- ative arrhythmia.

关 键 词：心房颤动 迷宫手术 围手术期 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]