迷宫Ⅳ术联合二尖瓣成形术在治疗二尖瓣病变合并心房颤动患者中的临床研究  

MazeⅣcombined with mitral angioplasty in the treatment of patients with mitral valve disease and atrial fibrillation

作　　者：浮志坤[1] 张向立[1] 张曙光 杨恒[1] 朱勇锋[1] 董炎 于慧娟[2] 郭琳[3] FU Zhikun;ZHANG Xiangli;ZHANG Shuguang;YANG Heng;ZHU Yongfeng;DONG Yan;YU Huijuan;GUO Lin(Department of Cardiac Surgery,Zhengzhou Seventh People's Hospital,Zhengzhou 450012,China)

机构地区：[1]郑州市第七人民医院心脏外科,450012 [2]郑州市第七人民医院超声科,450012 [3]郑州市第七人民医院重症监护室,450012

出　　处：《心肺血管病杂志》2020年第6期687-691,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨迷宫Ⅳ(MazeⅣ)术联合二尖瓣成形术在治疗二尖瓣病变合并心房颤动患者的临床效果。方法:回顾性分析2016年10月至2018年10月我院心脏外科因二尖瓣病变合并心房颤动治疗的患者217例临床资料。其中83例患者在MazeⅣ术同期行二尖瓣成形术(MVP组),134例患者在MazeⅣ术同期行二尖瓣置换术(MVR组)。其中MVP组男性56例、女性27例,年龄23~72岁,平均(45.9±8.5)岁,BMI:19.1~31.4 kg/m^2,平均(22.8±3.4)kg/m^2;MVR组男性85例、女性49例,年龄27~75岁,平均(46.3±5.7)岁,BMI:19.4~31.2 kg/m^2,平均(23.3±2.6)kg/m^2。收集两组患者的基线资料、术前超声结果、围术期资料、术后出院时及随访(术后3个月、6个月、12个月)复查心脏超声和心电图结果,分析MazeⅣ术联合MVP的临床效果。结果:两组患者基线资料对比差异无统计学意义(P>0.05)。MVP组的主动脉阻断时间、体外循环时间、手术操作时间较MVR延长,差异有统计学意义(P<0.05)。MVP组术后呼吸机辅助时间、并发症发生率(低心排、肾功能不全、肺部感染、左心室破裂)、病死率、ICU滞留时间较MVR组低,差异有统计学意义(P<0.05)。围术期引流量、住院时间没有明显差异(P>0.05)。MVP组出院时、术后3个月时窦性心律维持率较MVR组无明显差异(P>0.05),术后6个月、12个月时MVP组窦性心律维持率较MVR组明显改善(P<0.05),MVP组术后6个月LAD回缩、LVEDD回缩、肺动脉收缩压下降、LVEF改善较MVR组有明显差异(P<0.05)。结论:MazeⅣ术联合二尖瓣成形术在治疗二尖瓣病变和并心房颤动患者中能够降低围术期并发症,优化和改善左心房及及左心室的重构,提高患者窦性心律的转复和维持率,有效改善和提高患者预后生存质量。Objective:To investigate the clinical effect of mazeⅣcombined with mitral angioplasty in the treatment of patients with mitral valve disease and atrial fibrillation(AF).Methods:The clinical data of 217 patients with mitral valve disease and atrial fibrillation treated in our hospital from October 2016 to October 2018 were retrospectively analyzed.Among them,83 patients underwent mitral angioplasty(MVP group)during MazeⅣ,and 134 patients underwent mitral valve replacement(MVR group)during MazeⅣ.There were 56 males and 27 females in the MVP group,aged 23-72(45.9±8.5)years,and BMI:19.1-31.4(22.8±3.4)kg/m^2;85 males and 49 females,age 27-5(46.3±5.7)years old,BMI:19.4-31.2(23.3±2.6)kg/m^2.Collect baseline data,preoperative ultrasound result,perioperative data,postoperative discharge and follow-up(3 months,6 months,12 months)of the two groups of patients to review cardiac ultrasound and electrocardiogram result,and analyze MazeⅣsurgery Clinical effect of combined MVP.Results:There was no significant difference in baseline data between the two groups of patients(P>0.05).The aortic occlusion time,extracorporeal circulation time,and operation time of the MVP group were longer than those of the MVR,and there were statistical differences(P<0.05).The postoperative ventilator assist time,complication rate(low cardiac output,renal insufficiency,pulmonary infection,left ventricular rupture),mortality,and ICU retention time in the MVP group were lower than those in the MVR group,which were statistically significant(P<0.05).There was no significant difference in perioperative drainage and hospital stay(P>0.05).There was no significant difference in the rate of sinus rhythm maintenance in the MVP group compared with the MVR group at discharge and 3 months after surgery(P>0.05).The rate of sinus rhythm maintenance in the MVP group was significantly improved compared with the MVR group at 6 and 12 months after surgery.(P<0.05),the LAD retraction,LVEDD retraction,decreased pulmonary artery systolic blood pressure,and impr

关 键 词：迷宫Ⅳ术 二尖瓣成形 二尖瓣置换 心房颤动 

分 类 号：R54[医药卫生—心血管疾病]